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Sato K, Wakugami K, Iwata T, Tanaka S, Koike M, Ogawa T. Low muscle mass in patients with stroke on admission reduces walking ability at discharge. Clin Nutr ESPEN 2024; 61:333-337. [PMID: 38777452 DOI: 10.1016/j.clnesp.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Reduced skeletal muscle mass may negatively influence postural retention and walking function. This study aimed to examine the influence of the skeletal muscle mass index on walking function in patients with stroke. METHODS This study included patients with cerebral infarction aged ≥65 years. The Asian Working Group for Sarcopenia's skeletal muscle mass index criteria were used to classify the participants into the low and high skeletal muscle mass index groups. The patient characteristics of the two groups were compared. The primary and secondary outcome measures were independent walking and walking speed, respectively. RESULTS In total, 174 participants were included. There were no significant differences in the length of hospital stay, rehabilitation volume, or functional independence measure score at discharge between the males and females. Multivariate logistic regression analysis revealed that independent walking was independently associated with the skeletal muscle mass index on admission. The SMI, as an explanatory variable, was independently associated with the comfortable and fastest walking speeds. Faster walking was associated with higher skeletal muscle mass indexes on admission for both males and females. CONCLUSIONS A low skeletal muscle mass index negatively influences walking function improvement in patients with stroke. A strategy aimed at increasing skeletal muscle mass can have beneficial effects on walking function in patients with stroke.
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Affiliation(s)
- Keisuke Sato
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan; Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| | - Kiyoshi Wakugami
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan.
| | - Tsuyoshi Iwata
- Ginowan-kinen Hospital, 3-3-13 Ginowan, Ginowan City, Okinawa, 901-2211, Japan.
| | - Seiji Tanaka
- Department of Rehabilitation Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
| | - Masaki Koike
- Kobe College of Medical Welfare, 501-85, Fukushima, Mita City, Hyogo, 669-1313, Japan.
| | - Takahiro Ogawa
- Chuzan Hospital Clinical Education and Research Center, 6-2-1 Matsumoto, Okinawa City, Okinawa, 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University Graduate School of Medicine, 1-1 Yazakokarimata, Nagakute-city, Aichi, 480-1195, Japan.
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Korkusuz S, Kibar S, Özgören N, Arıtan S, Seçkinoğulları B, Balkan AF. Effect of Knee Hyperextension on Femoral Cartilage Thickness in Stroke Patients. Am J Phys Med Rehabil 2024; 103:371-376. [PMID: 37549370 DOI: 10.1097/phm.0000000000002323] [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: 08/09/2023]
Abstract
OBJECTIVE Knee hyperextension is one of the most common compensatory mechanisms in stroke patients. The first aim of the study was to measure knee hyperextension and femoral cartilage thickness in stroke patients. The second aim was to compare the femoral cartilage thickness of the paretic and nonparetic limbs in stroke patients with and without knee hyperextension. DESIGN Forty stroke patients were included in the study. The patients were divided into two groups according to the presence of knee hyperextension based on kinematic analyses performed during walking with a three-dimensional motion analysis system. The medial femoral cartilage, lateral femoral cartilage, and intercondylar cartilage thicknesses of the paretic and nonparetic sides of the patients were measured by ultrasonography. RESULTS In the study group, medial femoral cartilage, intercondylar, and lateral femoral cartilage thicknesses were less on the paretic side than on the nonparetic side, while the femoral cartilage thicknesses on the paretic and nonparetic sides were similar in the control group. Paretic side medial femoral cartilage and intercondylar thicknesses were less in the study group compared with the control group, and lateral femoral cartilage thickness was similar between the two groups. CONCLUSIONS Knee hyperextension during walking causes femoral cartilage degeneration in stroke patients.Clinical Trial code: NCT05513157.
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Affiliation(s)
- Süleyman Korkusuz
- From the Department of Therapy and Rehabilitation, Faculty of Health Sciences, Atılım University, Ankara, Turkey (SK); Department of Therapy and Rehabilitation, Vocational School of Health Services, Atılım University, Ankara, Turkey (SK); Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey (NÖ, SA); and Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey (BS, AFB)
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Ogihara H, Yamamoto N, Kurasawa Y, Kamo T, Hagiyama A, Hayashi S, Momosaki R. Characteristics and Methodological Quality of the Top 50 Most Influential Articles on Stroke Rehabilitation: A Bibliometric Analysis. Am J Phys Med Rehabil 2024; 103:363-369. [PMID: 38207163 DOI: 10.1097/phm.0000000000002412] [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: 01/13/2024]
Abstract
ABSTRACT This study aimed to conduct a comprehensive review of the top 50 most influential articles on stroke rehabilitation to investigate characteristics, such as the number of citations, year of publication, study design, and research topic, as well as to assess the evidence level and methodological quality. Moreover, we performed a supplementary assessment of the top 10 articles published within the past 5 yrs in the same domain, aiming to discern potential shifts in trends and methodological quality. Web of Science was used to search for articles on stroke rehabilitation. The data extracted from the articles included title, journal impact factor, year of publication, total number of citations, article topic, study design, and others. The level of evidence and methodological quality were assessed by two reviewers. Noninvasive brain stimulation and robotic rehabilitation were frequently discussed in the top 50 articles. We found that there was no difference in methodology quality between the top 50 articles in all years and the top ten articles in the past 5 yrs. Furthermore, the number of citations and citation density were not associated with the methodological quality. The findings suggest that the number of citations alone may not be a reliable indicator of research quality.
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Affiliation(s)
- Hirofumi Ogihara
- From the Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan (HO, YK); Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan (HO, NY, YK, TK, AH, SH, RM); Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan (NY, AH); Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Gunma, Japan (TK, SH); Division of Physical Medicine and Rehabilitation, Okayama University Hospital, Okayama, Japan (AH); and Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan (RM)
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Norlander A, Lindgren I, Brogårdh C. Factors associated with fatigue among people who have returned to work after stroke: an exploratory study. J Rehabil Med 2024; 56:jrm18668. [PMID: 38482970 PMCID: PMC10953709 DOI: 10.2340/jrm.v56.18668] [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: 09/10/2023] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke. DESIGN A cross-sectional exploratory study. SUBJECTS 87 working stroke survivors. METHODS This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created. RESULTS Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue. CONCLUSION Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.
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Affiliation(s)
- Anna Norlander
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
| | - Ingrid Lindgren
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden; Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
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Williams ER, Wilson HK, Ross RE, Gregory CM. Relative handgrip strength as a vitality measure in US stroke survivors. Disabil Rehabil 2024:1-7. [PMID: 38468552 DOI: 10.1080/09638288.2024.2327488] [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: 08/30/2023] [Accepted: 03/02/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Stroke is a leading cause of long-term disability in the US, yet a feasible assessment measure with predictive value for components of the International Classification of Functioning, Disability, and Health (ICF) Core Set for Stroke is lacking. The purpose of the present study was to explore the predictive value of potential assessment measures on factors within each ICF component in stroke survivors. MATERIALS AND METHODS Demographic, anthropometric, blood-based biomarker, physical functioning, and Global Physical Activity Questionnaire data were collected on stroke survivors in the 2011-2018 NHANES cycles. Potential predictors (handgrip strength relative to weight, age, sex, race, education level, marital status, poverty ratio, stroke chronicity) of physical function, activities of daily living (ADLs), participation in social activities, metabolic syndrome, and meeting physical activity recommendations were evaluated using weighted linear and ordinal logistic regression. RESULTS Relative handgrip strength was a significant predictor of physical function, difficulty participating in ADLs and social activities, and odds of meeting physical activity recommendations. As relative handgrip strength increased, these factors improved among stroke survivors. CONCLUSIONS To decrease disability rates and optimize function among stroke survivors, the use of assessment measures like relative handgrip strength that may predict multiple ICF components is warranted.
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Affiliation(s)
- Ewan R Williams
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah K Wilson
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC, USA
| | - Ryan E Ross
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
- Research Service, Ralph H. Johnson Veterans Affairs Healthcare System, Charleston, SC, USA
| | - Chris M Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
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Liguori S, Selb M, Moretti A, Paoletta M, Invernizzi M, Fiore P, Iolascon G, Gimigliano F. Characterization of an Italian population with neurological disorders in a rehabilitation setting using ClinFIT. J Rehabil Med 2024; 56:jrm18262. [PMID: 38236003 PMCID: PMC10809999 DOI: 10.2340/jrm.v56.18262] [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: 07/18/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To examine the functioning profile of people with neurological disorders who access rehabilitation services through ClinFIT Generic-30. METHODS The functioning profile of people with neurological disorders accessing rehabilitation services was examined using the ClinFIT Generic-30, and the results compared with existing core set (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury). RESULTS Data for 364 people were analysed. The 10 most commonly impaired ICF categories included 3 for Body Functions (exercise tolerance functions (b455), mobility of joint functions (b710), and muscle power functions (b730)) and 7 for Activities and Participation (carrying out daily routine (d230), handling stress and other psychological demands (d240), changing basic body position (d410), maintaining a body position (d415), transferring oneself (d420), walking (d450), and moving around (d455)), while the ICF categories that were severely impaired (ICF qualifiers 3 and 4) in more than 30% of the study cohort were: muscle power functions (b730), carrying out daily routine (d230), walking (d450), moving around (d455), doing housework (d640), and assisting others (d660). DISCUSSION The current study data suggests that ClinFIT Generic-30 appears to effectively identify impairments and/or restrictions, as perceived by individuals affected by selected health conditions. CONCLUSION ClinFIT Generic-30 is a tool that can be used to characterize functioning profile in people with different neurological disorders and to collect important information not addressed by the disease-specific core sets (neurological health conditions acute and post-acute,stroke, Multiple Sclerosis, Traumatic Brain Injury,Spinal Cord Injury).
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Affiliation(s)
- Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy.
| | - Melissa Selb
- Swiss Paraplegic Research, Nottwil, Switzerland; ICF Research Branch, Nottwil, Switzerland
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy; Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Pietro Fiore
- Neurological Rehabilitation and Spinal Unit, Bari, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
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Williams ER, VanDerwerker CJ, Ross RE, Evans EM, Gregory CM. Effect of power training on rate of torque development and spatiotemporal gait parameters post stroke. Clin Biomech (Bristol, Avon) 2023; 105:105953. [PMID: 37075545 PMCID: PMC10198926 DOI: 10.1016/j.clinbiomech.2023.105953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Maximizing independence and function post-stroke are two common therapy goals. Rate of torque development in lower-extremity muscles was recently reported to be associated with walking speed; however, trainability and subsequent effect on gait is unknown. This study aimed to determine effect of power training on paretic and non-paretic limb torque parameters, spatiotemporal gait parameters, and walking speed in chronic stroke survivors. METHODS Individuals with chronic stroke (n = 22; 7 females; 62.7 ± 8.8 yrs) completed 24 progressive power-training sessions over 8 weeks with pre and post assessments. Knee extensor strength was assessed via dynamometry with torque parameters measured from maximal voluntary isometric contractions. Gait speed and spatiotemporal gait parameters were assessed via an instrumented gait mat, and a 6-min walk test was performed. FINDINGS Rate of torque development at 200 ms and peak torque improved 58.6% and 14.1%, respectively, in the quadricep of the paretic limb (p < 0.05); conversely the non-paretic limb was unchanged. On average, self-selected walking speed, fastest-comfortable walking speed, and 6-min walk test improved 21.7%, 21.1%, and 19.5%, respectively (all p < 0.05). Change in torque development at 100 ms in the quadricep of the non-paretic limb was positively associated with improvements in self-selected and fastest-comfortable walking speeds (both r = 0.70, p < 0.05) and 6-min walk (r = 0.78, p < 0.001). INTERPRETATIONS These findings suggest power training may be an effective intervention for improving torque development in the quadricep of the paretic limb in individuals with chronic stroke. Further research to explore utility and mechanistic aspects of force development for gait function in chronic stroke survivors is warranted.
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Affiliation(s)
- Ewan R Williams
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Catherine J VanDerwerker
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA; Research Service, Ralph H Johnson, Veterans Affairs Healthcare System, Charleston, SC 29401, USA.
| | - Ryan E Ross
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA; Research Service, Ralph H Johnson, Veterans Affairs Healthcare System, Charleston, SC 29401, USA.
| | - Ellen M Evans
- Department of Kinesiology, Indiana University, Bloomington, IN 47405, USA.
| | - Chris M Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA; Research Service, Ralph H Johnson, Veterans Affairs Healthcare System, Charleston, SC 29401, USA.
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Tasseel-Ponche S, Roussel M, Toba MN, Sader T, Barbier V, Delafontaine A, Meynier J, Picard C, Constans JM, Schnitzler A, Godefroy O, Yelnik AP. Dual-task versus single-task gait rehabilitation after stroke: the protocol of the cognitive-motor synergy multicenter, randomized, controlled superiority trial (SYNCOMOT). Trials 2023; 24:172. [PMID: 36890548 PMCID: PMC9994785 DOI: 10.1186/s13063-023-07138-x] [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: 07/07/2022] [Accepted: 02/07/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Gait disorders and cognitive impairments are prime causes of disability and institutionalization after stroke. We hypothesized that relative to single-task gait rehabilitation (ST GR), cognitive-motor dual-task (DT) GR initiated at the subacute stage would be associated with greater improvements in ST and DT gait, balance, and cognitive performance, personal autonomy, disability, and quality of life in the short, medium and long terms after stroke. METHODS This multicenter (n=12), two-arm, parallel-group, randomized (1:1), controlled clinical study is a superiority trial. With p<0.05, a power of 80%, and an expected loss to follow-up rate of 10%, the inclusion of 300 patients will be required to evidence a 0.1-m.s-1 gain in gait speed. Trial will include adult patients (18-90 years) in the subacute phase (0 to 6 months after a hemispheric stroke) and who are able to walk for 10 m (with or without a technical aid). Registered physiotherapists will deliver a standardized GR program (30 min three times a week, for 4 weeks). The GR program will comprise various DTs (phasic, executive function, praxis, memory, and spatial cognition tasks during gait) in the DT (experimental) group and gait exercises only in the ST (control) group. The primary outcome measure is gait speed 6 months after inclusion. The secondary outcomes are post-stroke impairments (National Institutes of Health Stroke Scale and the motor part of the Fugl-Meyer Assessment of the lower extremity), gait speed (10-m walking test), mobility and dynamic balance (timed up-and-go test), ST and DT cognitive function (the French adaptation of the harmonization standards neuropsychological battery, and eight cognitive-motor DTs), personal autonomy (functional independence measure), restrictions in participation (structured interview and the modified Rankin score), and health-related quality of life (on a visual analog scale). These variables will be assessed immediately after the end of the protocol (probing the short-term effect), 1 month thereafter (the medium-term effect), and 5 months thereafter (the long-term effect). DISCUSSION The main study limitation is the open design. The trial will focus on a new GR program applicable at various stages after stroke and during neurological disease. TRIAL REGISTRATION NCT03009773 . Registered on January 4, 2017.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France. .,Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.
| | - Martine Roussel
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Monica N Toba
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Vincent Barbier
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Jonathan Meynier
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | - Carl Picard
- Clinical Research and Innovation Directorate, Amiens University Hospital, Amiens, France
| | | | - Alexis Schnitzler
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences, UR UPJV 4559, Jules Verne University of Picardie, Amiens, France.,Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain Pierre Yelnik
- PRM Department, Hôpital Lariboisière-F.Widal AP-HP, Paris, France.,UMR 9010, Paris University, Centre Borelli, Paris, France
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Maje AU, Ibrahim AA. Effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors: a protocol for randomised controlled trial. Trials 2023; 24:124. [PMID: 36803399 PMCID: PMC9942389 DOI: 10.1186/s13063-022-07057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Post-stroke gait deviations contribute to significant functional disability, impaired walking ability and poor quality of life. Prior studies suggest that gait training with paretic lower limb loading may improve gait parameters and walking ability in post-stroke. However, most gait training methods used in these studies are not readily available, and studies using cheaper methods are limited. OBJECTIVE The purpose of this study is to describe a protocol for a randomised controlled trial on the effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors. METHODS This is a two-center, single-blind, two-arm parallel randomised controlled trial. Forty-eight stroke survivors with mild to moderate disability will be recruited from two tertiary facilities and randomly assigned into two intervention arms; overground walking with paretic lower limb loading or overground walking without paretic lower limb loading in a 1:1 ratio. All interventions will be administered thrice weekly for 8 weeks. Primary outcomes will be step length and gait speed whereas the secondary outcomes will include step length symmetry ratio, stride length, stride length symmetry ratio, stride width, cadence and motor function. All outcomes will be assessed at baseline, 4, 8 and 20 weeks after the start of intervention. DISCUSSION This will be the first randomised controlled trial to report the effects of overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors from low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov NCT05097391. Registered on 27 October 2021.
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Affiliation(s)
- Abdulhamid U. Maje
- Department of Physiotherapy, Muhammadu Abdullahi Wase Teaching Hospital, Hospitals Management Board, P.M.B 3160, Kano, Kano State Nigeria ,grid.411585.c0000 0001 2288 989XDepartment of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, P.M.B 3011, Kano, Kano State Nigeria
| | - Aminu A. Ibrahim
- grid.510479.eDepartment of Physiotherapy, School of Basic Medical Sciences, Skyline University Nigeria, Kano, Kano State Nigeria
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Moore SA, Boyne P, Fulk G, Verheyden G, Fini NA. Walk the Talk: Current Evidence for Walking Recovery After Stroke, Future Pathways and a Mission for Research and Clinical Practice. Stroke 2022; 53:3494-3505. [PMID: 36069185 PMCID: PMC9613533 DOI: 10.1161/strokeaha.122.038956] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Achieving safe, independent, and efficient walking is a top priority for stroke survivors to enable quality of life and future health. This narrative review explores the state of the science in walking recovery after stroke and potential for development. The importance of targeting walking capacity and performance is explored in relation to individual stroke survivor gait recovery, applying a common language, measurement, classification, prediction, current and future intervention development, and health care delivery. Findings are summarized in a model of current and future stroke walking recovery research and a mission statement is set for researchers and clinicians to drive the field forward to improve the lives of stroke survivors and their carers.
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Affiliation(s)
- Sarah A Moore
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK, and Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (S.A.M.)
| | - Pierce Boyne
- Department of Rehabilitation Exercise and Nutritional Science, University of Cincinnati, OH (P.B.)
| | - George Fulk
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA (G.F.)
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Belgium (G.V.)
| | - Natalie A Fini
- Medicine Dentistry and Health Sciences, The University of Melbourne, Australia (N.A.F.)
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Lucka E, Lucki M, Cybulski M, Daroszewski P, Lisiński P. The Use of the ICF Classification Sheet to Assess Cognitive-Behavioral Disorders and Verbal Communication in Patients after Ischemic and Hemorrhagic Stroke during Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12127. [PMID: 36231428 PMCID: PMC9564461 DOI: 10.3390/ijerph191912127] [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: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Background: In patients after experiencing stroke, the cognitive-behavioral deficits and disorders of verbal communication limit the effectiveness of rehabilitation. The key is to diagnose them at an early stage of rehabilitation and to implement appropriate psychological and speech therapy. Objective: Identify differences in the frequency and effectiveness of cognitive-behavioral disorder therapy depending on the clinical type of stroke, assessed before and after rehabilitation treatment, and their presentation using the ICF (International Classification of Functioning, Disability, and Health) classification. Materials and Methods: The study was prospective and included the analysis of cognitive-behavioral and verbal communication disorders. The study consisted of 47 patients after intracerebral hemorrhage (ICH) and 47 patients after an ischemic stroke (IS) before the implementation of rehabilitation and after completing a 4-week rehabilitation. Results: In the group after ICH, psychological therapy significantly reduced the disturbances of consciousness and orientation (p < 0.001) and improved the speed of performing tasks in tests (p < 0.001). In patients after IS and ICH, memory and attention function improved significantly (p < 0.001). Moreover, in patients after ICH, language function deficits decreased significantly (p = 0.018). Mood disturbances were maintained in 17% of patients after ICH and 40% of patients after IS (p = 0.007). Speech therapy reduced speech articulation disorders and aphasia in 85% of patients after ICH (p = 0.001) and in 68% of patients after IS (p = 0.033). Conclusions: The frequency and type of cognitive-behavioral and verbal communication disorders vary depending on the history of ICH or IS. The ICF classification may be useful in assessing and analyzing cognitive-behavioral and verbal communication disorders, which may lead to the implementation of appropriate psychological and speech therapy at an early stage of rehabilitation and increase the effectiveness of the therapy.
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Affiliation(s)
- Ewa Lucka
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland
| | - Mateusz Lucki
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland
| | - Marcin Cybulski
- Department of Clinical Psychology, University of Medical Sciences, Bukowska 70 Str., 60-812 Poznań, Poland
| | - Przemysław Daroszewski
- Department of Organization and Management in Healthcare, University of Medical Sciences, 60-545 Poznań, Poland
| | - Przemysław Lisiński
- Department of Rehabilitation and Physiotherapy, University of Medical Sciences, 28 Czerwca 1956 Str., No 135/147, 60-545 Poznań, Poland
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12
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Meyer A, Hrdlicka HC, Cutler E, Hellstrand J, Meise E, Rudolf K, Grevelding P, Nankin M. Preliminary Evaluation of a Novel Body-Weight Supported Postural Perturbation Module for Gait and Balance Rehabilitation after Stroke. JMIR Rehabil Assist Technol 2022; 9:e31504. [PMID: 35080495 PMCID: PMC8924779 DOI: 10.2196/31504] [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: 06/24/2021] [Revised: 11/30/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Impaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement. Objective This study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke. Methods This unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison. Results The improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively). Conclusions Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. Trial Registration ClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161
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Affiliation(s)
- Amanda Meyer
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Henry Charles Hrdlicka
- Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Erica Cutler
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Jill Hellstrand
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Emily Meise
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Kaitlyn Rudolf
- Department of Inpatient Physical and Occupational Therapy, Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Pete Grevelding
- Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, US
| | - Matthew Nankin
- Frank H Netter MD School of Medicine, Quinnipiac University, North Haven, US
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13
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Bourbonnais D, Pelletier R, Azar J, Sille C, Goyette M. Training muscle activation patterns of the lower paretic extremity using directional exertion improves mobility in persons with hemiparesis: a pilot study. BMC Biomed Eng 2021; 3:12. [PMID: 34715935 PMCID: PMC8555217 DOI: 10.1186/s42490-021-00057-5] [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: 06/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Controlled static exertion performed in the sagittal plane on a transducer attached to the foot requires coordinated moments of force of the lower extremity. Some exertions and plantarflexion recruit muscular activation patterns similar to synergies previously identified during gait. It is currently unknown if persons with hemiparesis following stroke demonstrate similar muscular patterns, and if force feedback training utilizing static exertion results in improved mobility in this population. Methods Electromyographic (EMG) activity of eight muscles of the lower limb were recorded using surface electrodes in healthy participants (n = 10) and in persons with hemiparesis (n = 8) during an exertion exercise (task) performed in eight directions in the sagittal plane of the foot and a plantarflexion exercise performed at 20 and 40% maximum voluntary effort (MVE). Muscle activation patterns identified during these exertion exercises were compared between groups and to synergies reported in the literature during healthy gait using cosine similarities (CS). Functional mobility was assessed in four participants with hemiparesis using GAITRite® and the Timed Up and Go (TUG) test at each session before, during and after static force feedback training. Tau statistics were used to evaluate the effect on mobility before and after training. Measures of MVE and the accuracy of directional exertion were compared before and after training using ANOVAs. Spearman Rho correlations were also calculated between changes in these parameters and changes in mobility before and after the training. Results Muscle activation patterns during directional exertion and plantarflexion were similar for both groups of participants (CS varying from 0.845 to 0.977). Muscular patterns for some of the directional and plantarflexion were also similar to synergies recruited during gait (CS varying from 0.847 to 0.951). Directional exertion training in hemiparetic subjects resulted in improvement in MVE (p < 0.040) and task performance accuracy (p < 0.001). Hemiparetic subjects also demonstrated significant improvements in gait velocity (p < 0.032) and in the TUG test (p < 0.022) following training. Improvements in certain directional efforts were correlated with changes in gait velocity (p = 0.001). Conclusion Static force feedback training following stroke improves strength and coordination of the lower extremity while recruiting synergies reported during gait and is associated with improved mobility.
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Affiliation(s)
- Daniel Bourbonnais
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Pavillon du Parc, Bureau 403-8, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada.
| | - René Pelletier
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
| | - Joëlle Azar
- School of Rehabilitation, Université de Montréal, P.O. Box 6128, Pavillon du Parc, Bureau 403-8, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
| | - Camille Sille
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
| | - Michel Goyette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 300 Darlington Avenue, Montreal, QC, H3S 2J4, Canada
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14
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Palmcrantz S, Wall A, Vreede KS, Lindberg P, Danielsson A, Sunnerhagen KS, Häger CK, Borg J. Impact of Intensive Gait Training With and Without Electromechanical Assistance in the Chronic Phase After Stroke-A Multi-Arm Randomized Controlled Trial With a 6 and 12 Months Follow Up. Front Neurosci 2021; 15:660726. [PMID: 33967683 PMCID: PMC8100236 DOI: 10.3389/fnins.2021.660726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Movement related impairments and limitations in walking are common long-term after stroke. This multi-arm randomized controlled trial explored the impact of training with an electromechanically assisted gait training (EAGT) system, i.e., the Hybrid Assistive Limb® (HAL), when integrated with conventional rehabilitation focused on gait and mobility. Material and Methods: Participants, aged 18–70 years with lower extremity paresis but able to walk with manual support or supervision 1–10 years after stroke, were randomized to (A) HAL-training on a treadmill, combined with conventional rehabilitation interventions (HAL-group), or (B) conventional rehabilitation interventions only (Conventional group), 3 days/week for 6 weeks, or (C) no intervention (Control group). Participants in the Control group were interviewed weekly regarding their scheduled training. Primary outcome was endurance in walking quantified by the 6 Minute Walk Test (6MWT). A rater blinded to treatment allocation performed assessments pre- and post-intervention and at follow-ups at 6 and 12 months. Baseline assessment included the National Institute of Health Stroke Scale (NIHSS) and the Modified Ranking Scale (MRS). Secondary outcomes included the Fugl Meyer Assessment- Lower Extremity, 10 Meter Walk Test, Berg Balance Scale (BBS), Barthel Index (BI) and perceived mobility with the Stroke Impact Scale. Results: A total of 48 participants completed the intervention period. The HAL-group walked twice as far as the Conventional group during the intervention. Post-intervention, both groups exhibited improved 6 MWT results, while the Control group had declined. A significant improvement was only found in the Conventional group and when compared to the Control group (Tukey HSD p = 0.022), and not between the HAL group and Conventional group (Tukey HSD p = 0.258) or the HAL- group and the Control group (Tukey HSD p = 0.447). There was also a significant decline in the Conventional group from post-intervention to 6 months follow up (p = 0.043). The best fitting model to predict outcome included initial balance (BBS), followed by stroke severity (NIHSS), and dependence in activity and participation (BI and MRS). Conclusion: Intensive conventional gait training induced significant improvements long-term after stroke while integrating treadmill based EAGT had no additional value in this study sample. The results may support cost effective evidence-based interventions for gait training long-term after stroke and further development of EAGT. Trial registration: Published on clinicaltrials.gov (NCT02545088) August 24, 2015.
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Affiliation(s)
- Susanne Palmcrantz
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anneli Wall
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Skough Vreede
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Påvel Lindberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Anna Danielsson
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte K Häger
- Section for Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Jörgen Borg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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15
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Pike S, Lannin NA, Cameron L, Palit M, Cusick A. Chronic stroke survivors with upper limb spasticity: linking experience to the ICF. Disabil Rehabil 2021; 44:3925-3937. [PMID: 33725459 DOI: 10.1080/09638288.2021.1894490] [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: 10/21/2022]
Abstract
PURPOSE To identify the impact of upper limb spasticity on stroke survivors by linking their shared experience to the International Classification of Functioning, Disability, and Health (ICF). METHODS Ten community dwelling adults with a chronic stroke and spasticity, who had completed an upper limb rehabilitation trial participated in semi-structured interviews. Data were analysed using content analysis and linked to the ICF Comprehensive Core Set for stroke using standard linking rules. RESULTS Four hundred and thirty-nine meaningful concepts eligible for linking were identified. The majority (n = 178) linked to Body Function, n = 137 to Activities and Participation, n = 115 to Environmental Factors, and n = 9 to Body Structures. Sixty-two of the 130 Comprehensive Core Set categories were used; an additional eight were required to fully represent experience. Stroke survivors with upper limb spasticity use words and discuss topics concentrated around mental functions, functions of the joints and bones, muscles and movements, carrying, moving and handling objects, support and relationships with immediate family and health professionals, products and technology, and health services. CONCLUSIONS Half of the Comprehensive Core Set categories for stroke were relevant, but to adequately capture experience an additional eight were needed. The ICF category profile may be unique to our participants or may suggest further research is needed to determine if additions to core set categories are required.Implications for rehabilitationOur ICF mapping demonstrated that the Brief Core Set for stroke was not sufficient to capture the range of experience for stroke survivors with upper limb spasticity, instead the Comprehensive Core Set for stroke supplemented with eight clinical-cohort specific second-level-categories should be used.Our findings suggest that rehabilitation may better reflect lived experience if it focuses on Body Function (Chapters 1, 2, 4, 7), Activity and Participation (Chapters 1-9), and Environment (Chapters 1, 2, 3, 5) because Body Structure was rarely mentioned in this or previous post-stroke ICF mapping research.
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Affiliation(s)
- Shannon Pike
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Australia.,Wagga Wagga Ambulatory Rehabilitation Service, Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - Natasha A Lannin
- School of Allied Health, Human Services and Sport (Occupational Therapy), La Trobe University, Melbourne, Australia.,Department of Neurosciences, Monash University, Melbourne, Australia.,Occupational Therapy Department, Alfred Health, Melbourne, Australia
| | | | | | - Anne Cusick
- Discipline of Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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16
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Karlsson E, Gustafsson J. Validation of the international classification of functioning, disability and health (ICF) core sets from 2001 to 2019 - a scoping review. Disabil Rehabil 2021; 44:3736-3748. [PMID: 33535017 DOI: 10.1080/09638288.2021.1878562] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To investigate and summarize the literature on the validation of International classification of functioning, disability and health (ICF) core sets from 2001 to 2019 and explore what research methods have been used when validating ICF core sets.Methods: The current study is a scoping review using a structured literature search.Results: In total, 66 scientific articles were included, of which 23 ICF core sets were validated. Most validation studies were conducted in Europe using a quantitative methodology and were validated from the perspective of patients. Analysis methods differed considerably between the studies, and most ICF core sets were validated only once for a single target population or from a single perspective. The comprehensive core sets were validated more often than the brief core sets, and core sets for stroke and low back pain were validated most often.Conclusion: The results of the current study show that only 66% of the existing ICF core sets are validated. Many of the validation studies are conducted in a European context and from a single perspective. More validation studies of ICF core sets from the perspective of both patients and professionals are needed.Implications for rehabilitationICF core sets aim to facilitate assessments in clinical settings and research.Validation studies indicate in general that the ICF core sets are valid and relevant for patients and professionals in the specific areas explored and thus can be used in rehabilitation settings.To improve the quality of ICF core sets, more validation studies are needed for ICF core sets not yet tested and for ICF core sets that have been validated only in one study or for one specific population or target group.
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Affiliation(s)
- Elin Karlsson
- Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Swedish Institute of Disability Research (SIDR), Örebro University, Örebro, Sweden
| | - Johanna Gustafsson
- Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Swedish Institute of Disability Research (SIDR), Örebro University, Örebro, Sweden
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17
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Alnajjar F, Zaier R, Khalid S, Gochoo M. Trends and Technologies in Rehabilitation of Foot Drop: A Systematic Review. Expert Rev Med Devices 2021; 18:31-46. [PMID: 33249938 DOI: 10.1080/17434440.2021.1857729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Foot Drop (FD) is a condition, which is very commonly found in post-stoke patients; however it can also be seen in patients with multiple sclerosis, and cerebral palsy. It is a sign of neuromuscular damage caused by the weakness of the muscles. There are various approaches of FD's rehabilitation, such as physiotherapy, surgery, and the use of technological devices. Recently, researchers have worked on developing various technologies to enhance assisting and rehabilitation of FD. AREAS COVERED This review analyzes different types of technologies available for FD. This include devices that are available commercially or still under research. 101 studies published between 2015 and 2020 were identified for the review, many were excluded due to various reasons, e.g., were not robot-based devices, did not include FD as one of the targeted diseases, or was insufficient information. 24 studies that met our inclusion criteria were assessed. These studies were further classified into two different categories: robot-based ankle-foot orthosis (RAFO) and Functional Electrical Stimulation (FES) devices. EXPERT OPINION Studies included showed that both RAFO and FES showed considerable improvement in the gait cycle of the patients. Future trends are inclining towards integrating FES with other neuro-concepts such as muscle-synergies for further developments.
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Affiliation(s)
- Fady Alnajjar
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, UAE
- Intelligent Behavior Control Unit, RIKEN, Centre for Brain Science, Wako, Japan
| | - Riadh Zaier
- Department of Mechanical and Industrial Engineering, College of Engineering, Sultan Qaboos University, Al Khoudh, Muscat, Oman
| | - Sumayya Khalid
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, UAE
| | - Munkhjargal Gochoo
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Al Ain, UAE
- School of Information and Communication Technology, Ulaanbaatar, Mongolia
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18
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Pignolo L, Basta G, Carozzo S, Bilotta M, Todaro MR, Serra S, Ciancarelli I, Tonin P, Cerasa A. A body-weight-supported visual feedback system for gait recovering in stroke patients: A randomized controlled study. Gait Posture 2020; 82:287-293. [PMID: 33002839 DOI: 10.1016/j.gaitpost.2020.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet. DESIGN A single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments. SETTING Intensive rehabilitation unit (IRU) at the Institute S. Anna (Italy). PARTICIPANTS 63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups. TREATMENTS All groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group ("control") underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group). MAIN OUTCOME MEASURES Absolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up. RESULTS Significant interaction Group*Time effects scales (F2,126 = 5.1, p-level = 0.005, η²p = 0.25; F2,126 = 4.7, p-level = 0.007, η²p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p's ≤ 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment. CONCLUSION The proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.
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Affiliation(s)
| | | | | | | | | | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | | | - Antonio Cerasa
- S. Anna Institute, 88900, Crotone, Italy; Institute for Biomedical Research and Innovation, National Research Council, (IRIB-CNR), 87050, Mangone, CS, Italy.
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19
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Ogihara H, Tsushima E, Kamo T, Sato T, Matsushima A, Niioka Y, Asahi R, Azami M. Kinematic gait asymmetry assessment using joint angle data in patients with chronic stroke-A normalized cross-correlation approach. Gait Posture 2020; 80:168-173. [PMID: 32521470 DOI: 10.1016/j.gaitpost.2020.05.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/22/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait asymmetry is an important characteristic often studied in stroke patients. Several methods have been used to define gait asymmetry using joint angles. However, these methods may require normative data from healthy individuals as reference points. This study used normalized cross-correlation (CCnorm) to define kinematic gait asymmetry in individuals after stroke and investigated the usefulness of this assessment. RESEARCH QUESTION Is the analysis of kinematic gait asymmetry based on joint angle data using CCnorm useful for gait assessment in patients with chronic stroke? METHODS The study involved 12 patients with chronic stroke. A motion analysis system was used to record gait speed, hip joint angles, knee joint angles, ankle joint angles, stance time, and swing time. The CCnorm was calculated using the flexion-extension joint angles of hip, knee, and ankle in the sagittal plane to assess the degree of kinematic gait asymmetry. The symmetry ratio (SR) was calculated using stance and swing times to assess the degree of temporal gait asymmetry. Clinical outcomes were measured using the Fugl-Meyer Assessment for the lower extremity (FMA-LE), Berg Balance Scale (BBS), and Functional Independence Measure (FIM). RESULTS Hip CCnorm was correlated with SRswing (r=-0.612, p < 0.05). Knee CCnorm was correlated with SRstance (r = 0.807, p < 0.01), SRswing (r=-0.752, p < 0.05), gait speed (r = 0.654, p < 0.05), BBS (r = 0.717, p < 0.01), and FIM (r = 0.735, p < 0.01). SIGNIFICANCE Hip and knee joint CCnorm appear to be useful tools for the assessment of gait asymmetry in stroke patients. In addition, kinematic gait asymmetry of the knee joint could reflect physical function, balance, and activities of daily living. These findings underline the importance of using kinematic gait asymmetry assessment in chronic stroke patients.
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Affiliation(s)
- Hirofumi Ogihara
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145 Japan; Graduate School of Health Sciences, Hirosaki University, 66-1, Honcho, Hirosaki-city, Aomori, 036-8564 Japan.
| | - Eiki Tsushima
- Graduate School of Health Sciences, Hirosaki University, 66-1, Honcho, Hirosaki-city, Aomori, 036-8564 Japan
| | - Tomohiko Kamo
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145 Japan
| | - Takaaki Sato
- Graduate School of Health Sciences, Hirosaki University, 66-1, Honcho, Hirosaki-city, Aomori, 036-8564 Japan; Department of Physical Therapy, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda-city, Nagano, 386-0396 Japan
| | - Akira Matsushima
- Department of Neurology, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda-city, Nagano, 386-0396 Japan
| | - Yamato Niioka
- Department of Physical Therapy, School of Health Sciences, Aomori University of Health and Welfare, Mase 58-1, Hamadate, Aomori-city, Aomori, 030-8505 Japan
| | - Ryoma Asahi
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145 Japan
| | - Masato Azami
- Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145 Japan
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20
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Schicketmueller A, Lamprecht J, Hofmann M, Sailer M, Rose G. Gait Event Detection for Stroke Patients during Robot-Assisted Gait Training. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3399. [PMID: 32560256 PMCID: PMC7349052 DOI: 10.3390/s20123399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
Functional electrical stimulation and robot-assisted gait training are techniques which are used in a clinical routine to enhance the rehabilitation process of stroke patients. By combining these technologies, therapy effects could be further improved and the rehabilitation process can be supported. In order to combine these technologies, a novel algorithm was developed, which aims to extract gait events based on movement data recorded with inertial measurement units. In perspective, the extracted gait events can be used to trigger functional electrical stimulation during robot-assisted gait training. This approach offers the possibility of equipping a broad range of potential robot-assisted gait trainers with functional electrical stimulation. In particular, the aim of this study was to test the robustness of the previously developed algorithm in a clinical setting with patients who suffered a stroke. A total amount of N = 10 stroke patients participated in the study, with written consent. The patients were assigned to two different robot-assisted gait trainers (Lyra and Lokomat) according to their performance level, resulting in five recording sessions for each gait-trainer. A previously developed algorithm was applied and further optimized in order to extract the gait events. A mean detection rate across all patients of 95.8% ± 7.5% for the Lyra and 98.7% ± 2.6% for the Lokomat was achieved. The mean type 1 error across all patients was 1.0% ± 2.0% for the Lyra and 0.9% ± 2.3% for the Lokomat. As a result, the developed algorithm was robust against patient specific movements, and provided promising results for the further development of a technique that can detect gait events during robot-assisted gait training, with the future aim to trigger functional electrical stimulation.
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Affiliation(s)
- Andreas Schicketmueller
- HASOMED GmbH, Paul-Ecke-Str. 1, 39114 Magdeburg, Germany;
- Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg, Universitaetsplatz 2, 39106 Magdeburg, Germany;
| | - Juliane Lamprecht
- MEDIAN Neurological Rehabilitation Center Magdeburg, Gustav-Ricker-Str. 4, 39120 Magdeburg, Germany; (J.L.); (M.S.)
- Institute for Neurorehabilitation, Affiliated Institute of the Otto-von-Guericke University, Gustav-Ricker-Str. 4, 39120 Magdeburg, Germany
| | - Marc Hofmann
- HASOMED GmbH, Paul-Ecke-Str. 1, 39114 Magdeburg, Germany;
| | - Michael Sailer
- MEDIAN Neurological Rehabilitation Center Magdeburg, Gustav-Ricker-Str. 4, 39120 Magdeburg, Germany; (J.L.); (M.S.)
- Institute for Neurorehabilitation, Affiliated Institute of the Otto-von-Guericke University, Gustav-Ricker-Str. 4, 39120 Magdeburg, Germany
- MEDIAN Clinic Flechtingen, Parkstraße, 39345 Flechtingen, Germany
| | - Georg Rose
- Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg, Universitaetsplatz 2, 39106 Magdeburg, Germany;
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Perin C, Bolis M, Limonta M, Meroni R, Ostasiewicz K, Cornaggia CM, Alouche SR, da Silva Matuti G, Cerri CG, Piscitelli D. Differences in Rehabilitation Needs after Stroke: A Similarity Analysis on the ICF Core Set for Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124291. [PMID: 32560129 PMCID: PMC7345505 DOI: 10.3390/ijerph17124291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O, >65 years old) and younger (Y, ≤65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales was translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y (n = 35, 46.17 ± 11.27 years old) and O (n = 35, 76.43 ± 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
- Correspondence: ; Tel.: +39-03-6298-6446; Fax: +39-03-6298-6439
| | - Marta Bolis
- Casa di cura Beato Palazzolo, 24122 Bergamo, Italy;
| | - Marco Limonta
- Istituti Clinici Zucchi, 20841 Carate Brianza, Italy;
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, 4671 Differdange, Luxembourg;
| | | | - Cesare Maria Cornaggia
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
| | - Sandra Regina Alouche
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil;
| | - Gabriela da Silva Matuti
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil;
- Associação de Assistência à Criança Deficiente (AACD), 04027-000 São Paulo, Brazil;
| | - Cesare Giuseppe Cerri
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
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Park SJ, Oh S. Changes in Gait Performance in Stroke Patients after Taping with Scapular Setting Exercise. Healthcare (Basel) 2020; 8:healthcare8020128. [PMID: 32397219 PMCID: PMC7349882 DOI: 10.3390/healthcare8020128] [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: 03/18/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to investigate the effects of combined taping with scapular setting exercise on the gait performance of stroke patients. Twenty stroke patients were randomly allocated to two groups: the taping with scapular setting exercise (TSSE) group (n = 10) and scapular setting exercise (SSE) group (n = 10). Intervention was performed for one week, and pre- and postintervention results for TSSE and SSE were compared. Outcomes were determined using the inertia measurement unit, which can measure spatiotemporal gait parameters, and using the timed up-and-go test. Two-way repeated analysis was used to compare pre- and postintervention results. In the TSSE group, intervention significantly improved cadence, gait speed, stride length, step length, gait cycle, swing phase duration, double support duration, and timed up-and-go test results more than in the SSE group. TSSE was found to improve all spatiotemporal gait parameters examined; thus, we recommend TSSE be considered as an intervention to improve gait parameters in stroke patients.
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Affiliation(s)
- Shin Jun Park
- Department of Physical Therapy, Gangdong University, 278, Daehak-gil, Gamgok-myeon, Eumseong-gun, Chungcheongbuk-do 27600, Korea;
| | - Seunghue Oh
- Department of Physical Therapy, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 330-714, Korea
- Correspondence: ; Tel.: +82-41-550-6103
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23
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Ju S. Correlation between lower limb muscle asymmetry during the sit-to-stand task and spatiotemporal gait asymmetry in subjects with stroke. J Exerc Rehabil 2020; 16:64-68. [PMID: 32161736 PMCID: PMC7056475 DOI: 10.12965/jer.2040030.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/05/2020] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to investigate the relationship between the both lower limb muscle asymmetry during sit-to-stand (STS) and spatiotemporal gait asymmetry in subjects with stroke. Twenty-nine patients were included in this study, lower limb muscle (rectus femoris, tibialis anterior, gastrocnemius) asymmetry during STS, five times sit-to-stand (FTSTS) and spatiotemporal (speed, step length, step time, swing time, stance time, single support time) gait asymmetry were measured. According to the results of the measurement, significant positive correlations between gastrocnemius and rectus femoris asymmetry during STS and step length asymmetry. Furthermore, significant positive correlations between rectus femoris asymmetry during STS and step time asymmetry. In addition, significant negative correlations between the FTSTS and gait speed. This study's results suggested that necessary to apply exercise that the gastrocnemius and rectus femoris symmetry during STS for improving step length and step time symmetry of gait, and necessary to apply exercise that increase STS speed for gait speed.
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Affiliation(s)
- Sungkwang Ju
- Department of Physical Therapy, Kaya University, Gimhae, Korea
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24
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Wall A, Borg J, Vreede K, Palmcrantz S. A randomized controlled study incorporating an electromechanical gait machine, the Hybrid Assistive Limb, in gait training of patients with severe limitations in walking in the subacute phase after stroke. PLoS One 2020; 15:e0229707. [PMID: 32109255 PMCID: PMC7048283 DOI: 10.1371/journal.pone.0229707] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 02/11/2020] [Indexed: 01/21/2023] Open
Abstract
Early onset, intensive and repetitive, gait training may improve outcome after stroke but for patients with severe limitations in walking, rehabilitation is a challenge. The Hybrid Assistive Limb (HAL) is a gait machine that captures voluntary actions and support gait motions. Previous studies of HAL indicate beneficial effects on walking, but these results need to be confirmed in blinded, randomized controlled studies. This study aimed to explore effects of incorporating gait training with HAL as part of an inpatient rehabilitation program after stroke. Thirty-two subacute stroke patients with severe limitations in walking were randomized to incorporated HAL training (4 days/week for 4 weeks) or conventional gait training only. Blinded assessments were carried out at baseline, after the intervention, and at 6 months post stroke. The primary outcome was walking independence according to the Functional Ambulation Categories. Secondary outcomes were the Fugl-Meyer Assessment, 2-Minute Walk Test, Berg Balance Scale, and the Barthel Index. No significant between-group differences were found regarding any primary or secondary outcomes. At 6 months, two thirds of all patients were independent in walking. Prediction of independent walking at 6 months was not influenced by treatment group, but by age (OR 0.848, CI 0.719-0.998, p = 0.048). This study found no difference between groups for any outcomes despite the extra resources required for the HAL training, but highlights the substantial improvements in walking seen when evidence-based rehabilitation is provided to patients, with severe limitations in walking in the subacute stage after stroke. In future studies potential subgroups of patients who will benefit the most from electromechanically-assisted gait training should be explored.
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Affiliation(s)
- Anneli Wall
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Vreede
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Palmcrantz
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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25
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Wall A, Borg J, Palmcrantz S. Self-perceived functioning and disability after randomized conventional and electromechanically-assisted gait training in subacute stroke: A 6 months follow-up. NeuroRehabilitation 2019; 45:501-511. [PMID: 31868699 DOI: 10.3233/nre-192929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Few previous studies have assessed self-perceived functioning, disability and recovery after electromechanically-assisted gait training (EAGT). OBJECTIVE To compare self-perceived functioning, disability and recovery after EAGT and after conventional gait training in the subacute stage after stroke, using the Stroke Impact Scale (SIS), and factors associated with self-perceived recovery, assessed at 6 months after stroke. METHODS Patients were randomized into two groups performing a 4-week intervention period of incorporated EAGT using the Hybrid Assistive Limb (HAL) or conventional physiotherapy only. RESULTS There were no significant differences in self-perceived strength, ADL, mobility, participation and percentage of recovery between intervention groups (p > 0.05). Self-perceived mobility was associated with improvements in objectively assessed walking speed/endurance and balance (R2 0.717, p = 0.002), and self-perceived recovery with self-perceived activities of daily living (ADL) ability (R2 0.34, p = 0.001). CONCLUSIONS This study indicates that EAGT and conventional gait training in the subacute stage after stroke have no differential impact on self-perceived functioning, disability and recovery at 6 months after stroke. Further, the study highlights the importance of interventions targeting ADL and self-care independence during stroke rehabilitation to enhance self-perceived recovery and clinical aspects to be targeted to enhance perceived mobility.
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Affiliation(s)
- Anneli Wall
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Jörgen Borg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Susanne Palmcrantz
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
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Shi B, Chen X, Yue Z, Yin S, Weng Q, Zhang X, Wang J, Wen W. Wearable Ankle Robots in Post-stroke Rehabilitation of Gait: A Systematic Review. Front Neurorobot 2019; 13:63. [PMID: 31456681 PMCID: PMC6700322 DOI: 10.3389/fnbot.2019.00063] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Stroke causes weak functional mobility in survivors and affects the ability to perform activities of daily living. Wearable ankle robots are a potential intervention for gait rehabilitation post-stroke. Objective: The aim of this study is to provide a systematic review of wearable ankle robots, focusing on the overview, classification and comparison of actuators, gait event detection, control strategies, and performance evaluation. Method: Only English-language studies published from December 1995 to July 2018 were searched in the following databases: PubMed, EMBASE, Web of Science, Scopus, IEEE Xplore, Science Direct, SAGE journals. Result: A total of 48 articles were selected and 97 stroke survivors participated in these trials. Findings showed that few comparative trials were conducted among different actuators or control strategies. Moreover, mixed sensing technology which combines kinematic with kinetic information was effective in detecting motion intention of stroke survivors. Furthermore, all the selected clinical studies showed an improvement in the peak dorsiflexion degree of the swing phase, propulsion on the paretic side during push-off, and further enhanced walking speed after a period of robot-assisted ankle rehabilitation training. Conclusions: Preliminary findings suggest that wearable ankle robots have certain clinical benefits for the treatment of hemiplegic gait post-stroke. In the near future, a multicenter randomized controlled clinical trial is extremely necessary to enhance the clinical effectiveness of wearable ankle robots.
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Affiliation(s)
- Bin Shi
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | | - Zan Yue
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | - Shuai Yin
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | | - Xue Zhang
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | - Jing Wang
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
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Charalambous CC, Alcantara CC, French MA, Li X, Matt KS, Kim HE, Morton SM, Reisman DS. A single exercise bout and locomotor learning after stroke: physiological, behavioural, and computational outcomes. J Physiol 2018; 596:1999-2016. [PMID: 29569729 PMCID: PMC5978382 DOI: 10.1113/jp275881] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/12/2018] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Previous work demonstrated an effect of a single high-intensity exercise bout coupled with motor practice on the retention of a newly acquired skilled arm movement, in both neurologically intact and impaired adults. In the present study, using behavioural and computational analyses we demonstrated that a single exercise bout, regardless of its intensity and timing, did not increase the retention of a novel locomotor task after stroke. Considering both present and previous work, we postulate that the benefits of exercise effect may depend on the type of motor learning (e.g. skill learning, sensorimotor adaptation) and/or task (e.g. arm accuracy-tracking task, walking). ABSTRACT Acute high-intensity exercise coupled with motor practice improves the retention of motor learning in neurologically intact adults. However, whether exercise could improve the retention of locomotor learning after stroke is still unknown. Here, we investigated the effect of exercise intensity and timing on the retention of a novel locomotor learning task (i.e. split-belt treadmill walking) after stroke. Thirty-seven people post stroke participated in two sessions, 24 h apart, and were allocated to active control (CON), treadmill walking (TMW), or total body exercise on a cycle ergometer (TBE). In session 1, all groups exercised for a short bout (∼5 min) at low (CON) or high (TMW and TBE) intensity and before (CON and TMW) or after (TBE) the locomotor learning task. In both sessions, the locomotor learning task was to walk on a split-belt treadmill in a 2:1 speed ratio (100% and 50% fast-comfortable walking speed) for 15 min. To test the effect of exercise on 24 h retention, we applied behavioural and computational analyses. Behavioural data showed that neither high-intensity group showed greater 24 h retention compared to CON, and computational data showed that 24 h retention was attributable to a slow learning process for sensorimotor adaptation. Our findings demonstrated that acute exercise coupled with a locomotor adaptation task, regardless of its intensity and timing, does not improve retention of the novel locomotor task after stroke. We postulate that exercise effects on motor learning may be context specific (e.g. type of motor learning and/or task) and interact with the presence of genetic variant (BDNF Val66Met).
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Affiliation(s)
| | - Carolina C Alcantara
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Margaret A French
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Xin Li
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Kathleen S Matt
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Hyosub E Kim
- Department of Psychology and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Susanne M Morton
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
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28
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Paanalahti M, Berzina G, Lundgren-Nilsson Å, Arndt T, Sunnerhagen KS. Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale. Disabil Rehabil 2018; 41:508-513. [PMID: 29502463 DOI: 10.1080/09638288.2017.1396368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine if the International Classification of Functioning (ICF) core set for stoke contains problems that are relevant for the persons living with stroke as expressed in the Stroke Impact Scale (SIS). METHODS Cross-sectional study of 242 persons with previous stroke. The agreement between the perceived problems in the SIS items and problems in the categories of Comprehensive ICF Core Set for stroke were analyzed using percent of agreement and Kappa statistic. RESULTS The analyses between 57 items of the SIS and 31 second-level categories of the ICF were conducted. The problems in domains of "Mobility", "Activities of daily living", "Hand function", "Strength" in the SIS had moderate agreement when compared to ICF categories. The SIS domains of "Emotion" and "Communication", as well as some aspects of the "Memory" had slight or fair agreement with corresponding ICF categories. The results of the study suggest that there is acceptable agreement between persons after stroke and health professionals in the physical aspects, but rather poor agreement in the cognitive and emotional aspects of functioning. CONCLUSIONS Health professionals do not fully capture the magnitude of emotional or social problems experienced by persons after stroke when using the ICF Core Set as a framework for evaluation. Implications for Rehabilitation The ICF Core Set for Stroke provides comprehensive list of possible health and health related outcomes for persons after stroke. Problems reported in condition-specific patient-reported outcome scales can be important in decision making in rehabilitation. Patients and health professionals tend to agree more on physical than cognitive problems. Examination of the relevance of the ICF cores set for stroke by comparing with the Stroke Impact Scale.
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Affiliation(s)
- Markku Paanalahti
- a Rehabilitation Medicine , Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Guna Berzina
- b Department of Rehabilitation , Riga Stradiņš University , Riga , Latvia
| | - Åsa Lundgren-Nilsson
- a Rehabilitation Medicine , Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Toni Arndt
- c Swedish School of Sport and Health Sciences , Stockholm , Sweden
| | - Katharina S Sunnerhagen
- a Rehabilitation Medicine , Institute for Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Abstract
Stroke, or cerebrovascular accident, involves injury to the central nervous system as a result of a vascular cause, and is a leading cause of disability worldwide. People with stroke often experience sensory, cognitive, and motor sequelae that can lead to difficulty walking, controlling balance in standing and voluntary tasks, and reacting to prevent a fall following an unexpected postural perturbation. This chapter discusses the interrelationships between stroke-related impairments, problems with control of balance and gait, fall risk, fear of falling, and participation in daily physical activity. Rehabilitation can improve balance and walking function, and consequently independence and quality of life, for those with stroke. This chapter also describes effective interventions for improving balance and walking function poststroke, and identifies some areas for further research in poststroke rehabilitation.
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Affiliation(s)
- Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute, University Health Network and Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - William E Mcilroy
- Department of Kinesiology, University of Waterloo and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Waterloo, ON, Canada
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30
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DAUNORAVIČENĖ KRISTINA, LINKEL ARTURAS, ŽIŽIENĖ JURGITA, GRIŠKEVIČIUS JULIUS, JUOCEVIČIUS ALVYDAS, RAUDONYTĖ INGA, PAUK JOLANTA, IDZKOWSKI ADAM, WALENDZIUK WOJCIECH. ALTERNATIVE METHOD OF UPPER EXTREMITY FUNCTION ASSESSMENT OF STROKE PATIENTS BY ANGULAR KINEMATIC PARAMETERS. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study focuses on the functional assessment of the upper extremity of stroke patients via analysis of angular kinematics features. Amplitudes and angular velocities of multi-joint movements more precisely describe functional state at different impairment levels. However, the arm movement as a whole could be analyzed by means of joint angle–angle diagrams, which illustrate the 2D trajectory of upper extremity during movement and show the visual ranges of upper extremity in different cycles of motion. The functional range of motion of each upper extremity segment in all patient groups for more accurate assessment of capability was calculated. Moreover, we calculated the area (S) between two curves in joint angle–angle diagrams as a novel index of the complete upper extremity movement range evaluation. Our findings correspond to clinical rates and upper extremity assessment based on joint angle–angle diagrams seems to be a promising method for accurate assessment and/or predicting the outcomes of rehabilitation programs.
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Affiliation(s)
- KRISTINA DAUNORAVIČENĖ
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - ARTURAS LINKEL
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - JURGITA ŽIŽIENĖ
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - JULIUS GRIŠKEVIČIUS
- Department of Biomechanics, Vilnius Gediminas Technical University, J. Basanavicius str. 28, MR-II 2-109 Vilnius, LT-03224, Lithuania
| | - ALVYDAS JUOCEVIČIUS
- Faculty of Medicine, Vilnius University, M.K. Ciurlionio str. 21 Vilnius, LT-03101, Lithuania
| | - INGA RAUDONYTĖ
- Faculty of Medicine, Vilnius University, M.K. Ciurlionio str. 21 Vilnius, LT-03101, Lithuania
| | - JOLANTA PAUK
- Mechanical Engineering Faculty, Bialystok University of Technology, Wiejska 45C, Bialystok, 15-351, Poland
| | - ADAM IDZKOWSKI
- Faculty of Electrical Engineering, Bialystok University of Technology, Wiejska 45D, Bialystok, 15-351, Poland
| | - WOJCIECH WALENDZIUK
- Faculty of Electrical Engineering, Bialystok University of Technology, Wiejska 45D, Bialystok, 15-351, Poland
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31
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Ganesh S, Mohapatra S, Mohanty P, Pattnaik M, Mishra C. Identification of the components associated with functioning using the international classification of functioning, disability and health comprehensive core set for stroke in Indian stroke survivors. Top Stroke Rehabil 2017; 24:517-526. [PMID: 28545344 DOI: 10.1080/10749357.2017.1330231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Rehabilitation interventions are expected to ensure best possible recovery and minimize functional disability in stroke survivors. However, not many studies have investigated patterns of recovery and outcomes after stroke in low-income countries. The objective of this study is to identify the biological, psychological, and social components associated with functioning over time in Indian stroke patients using the International Classification of Functioning, Disability and Health (ICF)-based tools and the Functional Independence Measure (FIM). METHODS The functioning profile of stroke survivors who received a standard multi-disciplinary rehabilitation was prospectively assessed using the ICF and the FIM at admission (baseline), at 12 & 24 weeks. Descriptive analyses were performed to identify changes in the frequencies of ICF categories and qualifiers from admission to follow-up. RESULTS One hundred and twenty-seven participants (mean age of 56 years) with mean FIM score 68 at baseline participated and completed the study. The mean FIM score at follow-up was 108. The numbers and frequency of ICF categories for activities and participation reduced after rehabilitation. More numbers of environmental factors were identified as barriers at follow-up (15 out of 33) compared to baseline. Within the components of Activities and Participation, significant improvement in functioning was found in 43 out of 51 categories. CONCLUSION The results show a reduction in frequencies in ICF activities and participation categories corresponding to basic activities of daily living. Categories corresponding to employment and social integration showed little or no improvement.
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Affiliation(s)
- Shankar Ganesh
- a Department of Physiotherapy, Demonstrator in Physiotherapy , SVNIRTAR , Cuttack , India
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32
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Aaron SE, Hunnicutt JL, Embry AE, Bowden MG, Gregory CM. POWER training in chronic stroke individuals: differences between responders and nonresponders. Top Stroke Rehabil 2017; 24:496-502. [PMID: 28482762 DOI: 10.1080/10749357.2017.1322249] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lower extremity muscle weakness is a primary contributor to post-stroke dysfunction. Resistance training is an effective treatment for hemiparetic weakness and improves walking performance. Post-stroke subject characteristics that do or do not improve walking speed following resistance training are unknown. OBJECTIVE The purpose of this paper was to describe baseline characteristics, as well as responses to training, associated with achieving a minimal clinically important difference (MCID) in walking speed (≥0.16 m/s) following Post-stroke Optimization of Walking Using Explosive Resistance (POWER) training. METHODS Seventeen participants completed 24 sessions of POWER training, which included intensive progressive leg presses, jump training, calf raises, sit-to-stands, step-ups, and over ground fast walking. Outcomes included SSWS, FCWS, DGI, FMA-LE, 6-MWT, paretic knee power, non-paretic knee power, and paretic step ratio. RESULTS Specific to those who reached MCID in SSWS (e.g. "responders"), significant improvements in SSWS, FCWS, 6-MWT, paretic knee power, and non-paretic knee power was realized. Paretic knee power and non-paretic knee power significantly improved in those who did not achieve MCID for gait speed (e.g. "non-responders"). CONCLUSION The potential for POWER training to enhance general locomotor function was confirmed. Baseline paretic knee strength/power may be an important factor in how an individual responds to this style of training. The lack of change within the non-responders emphasizes the contribution of factors other than lower extremity muscle power improvement to locomotor dysfunction.
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Affiliation(s)
- Stacey E Aaron
- a Department of Health Sciences and Research, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA
| | - Jennifer L Hunnicutt
- a Department of Health Sciences and Research, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA
| | - Aaron E Embry
- a Department of Health Sciences and Research, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA.,b Division of Physical Therapy, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA.,c Ralph H. Johnson VA Medical Center , Charleston , SC , USA
| | - Mark G Bowden
- a Department of Health Sciences and Research, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA.,b Division of Physical Therapy, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA.,c Ralph H. Johnson VA Medical Center , Charleston , SC , USA
| | - Chris M Gregory
- a Department of Health Sciences and Research, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA.,b Division of Physical Therapy, College of Health Professions , Medical University of South Carolina , Charleston , SC , USA.,c Ralph H. Johnson VA Medical Center , Charleston , SC , USA
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Evans M, Hocking C, Kersten P. Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning, Disability and Health Core Set for Stroke. Disabil Rehabil 2016; 39:2544-2550. [DOI: 10.1080/09638288.2016.1239763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Melissa Evans
- Department of Occupational Science and Therapy, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Clare Hocking
- Department of Occupational Science and Therapy, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Paula Kersten
- School of Health Sciences, University of Brighton, Brighton, UK
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Bērziņa G, Smilškalne B, Vētra A, Stibrant Sunnerhagen K. Living in Latvia after stroke: the association between functional, social and personal factors and the level of self-perceived disability-a cross-sectional study. BMJ Open 2016; 6:e010327. [PMID: 27342238 PMCID: PMC4932322 DOI: 10.1136/bmjopen-2015-010327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate how functional, social and personal factors are associated with self-perceived level of disability in the chronic phase of stroke in a Latvian stroke population. The consequences of stroke can vary greatly and often leads to long-term disability that, according to the WHO definitions, depends on the interaction between the person and his/her context. DESIGN Cross-sectional study with retrospective data gathering. SETTING Community-dwelling persons who received specialised in-patient rehabilitation after stroke in Latvia. PARTICIPANTS Of 600 persons after stroke who were identified through hospital register and selected for the study, 255 were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The medical information and discharge data of the Functional Independence Measure (FIM) was extracted from medical records. Participants filled out a questionnaire on sociodemographic information and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), either in Latvian or Russian, depending on their wish when contacted for their oral agreement to participate. Stepwise multiple regression analysis was conducted to find a model that best explains the variance in WHODAS 2.0 scores. RESULTS The models explained 23-43.5% of variance in outcomes. The best explained WHODAS 2.0 domains were 'mobility' and 'self-care'. The significant factors were level of independence in 'self-care', 'locomotion' and 'communication' according to FIM, as well as working status, time since rehabilitation, age, gender, living alone or in family and preferred language. CONCLUSIONS Functional, social and personal factors are of similar importance when explaining self-perceived disability in the chronic phase of stroke. Some, but not all, of the factors are modifiable by the healthcare system. Therefore, a complex approach and involvement of medical, social and political systems is needed.
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Affiliation(s)
- Guna Bērziņa
- Department of Rehabilitation, Riga Stradiņš University, Riga, Latvia
| | - Baiba Smilškalne
- Department of Secondary Outpatient Care, Psycho-neurological Hospital for Children “Ainaži”, Ainaži, Latvia
| | - Anita Vētra
- Department of Rehabilitation, Riga Stradiņš University, Riga, Latvia
| | - Katharina Stibrant Sunnerhagen
- Section for Clinical Neuroscience and Rehabilitation, University of Gothenburg, the Sahlgrenska Academy, Gothenburg, Sweden
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Norlander A, Jönsson AC, Ståhl A, Lindgren A, Iwarsson S. Activity among long-term stroke survivors. A study based on an ICF-oriented analysis of two established ADL and social activity instruments. Disabil Rehabil 2016; 38:2028-37. [PMID: 26729231 DOI: 10.3109/09638288.2015.1111437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe activity in different aspects of daily life among long-term stroke survivors, and conceptualise the content of the Barthel Index (BI) and the Swedish extended and modified Frenchay Activities Index (mFAI) using the ICF framework. METHOD Assessments were performed by means of the BI and the mFAI at a 10-year follow-up of 145 consecutive stroke survivors from Lund Stroke Register, Sweden. After linking the two instruments to the ICF core set for stroke, data were analysed and presented in terms of activity-specific domain-scores for the total sample and sub-groups according to gender and age. RESULTS Together the two instruments covered 69% of the Activities and participation component of the ICF core set for stroke. Two activity-specific domains were identified within the BI and six within the mFAI. Most participants reported a high overall activity level. Inactivity was most common among those ≥80 years. Men and women participated in different types of activities and used different modes of transport. CONCLUSIONS Long-term stroke survivors have a high activity level in daily life, though individual variation is considerable. The structure provided by linking instruments to the ICF core set for stroke can be used for more fine-tuned descriptions of activity. Implications for Rehabilitation Since most long-term stroke survivors are independent in ADL but may have limitations in other activity domains such as social and leisure activities, these aspects should be considered in the rehabilitation process. Older stroke survivors deserve special attention due to their higher risk of long-term inactivity. The Barthel Index and the Swedish extended and modified Frenchay Activities Index are complementary for assessments of ADL and social activity after stroke and cover over two thirds of the Activities and participation component in the ICF core set for stroke.
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Affiliation(s)
- Anna Norlander
- a Department of Health Sciences , Lund University , Lund , Sweden
| | | | - Agneta Ståhl
- b Department of Technology and Society , Lund University , Lund , Sweden
| | - Arne Lindgren
- c Department of Clinical Sciences, Neurology , Lund University , Lund , Sweden ;,d Department of Neurology and Rehabilitation Medicine , Skåne University Hospital , Lund , Sweden
| | - Susanne Iwarsson
- a Department of Health Sciences , Lund University , Lund , Sweden
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Beyaert C, Vasa R, Frykberg GE. Gait post-stroke: Pathophysiology and rehabilitation strategies. Neurophysiol Clin 2015; 45:335-55. [PMID: 26547547 DOI: 10.1016/j.neucli.2015.09.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/14/2015] [Accepted: 09/22/2015] [Indexed: 12/16/2022] Open
Abstract
We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.
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Affiliation(s)
- C Beyaert
- EA3450, Université de Lorraine, Faculty of Medicine, 54500 Vandœuvre-lès-Nancy, France; Motion Analysis Laboratory, L.-Pierquin Rehabilitation Center, 54000 Nancy, France.
| | - R Vasa
- RV Foundation, Centre for Brain and Spinal Injury Rehab, Mumbai, India
| | - G E Frykberg
- Department of Neuroscience/Rehabilitation Medicine, Uppsala University, 75158 Uppsala, Sweden
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Tavener M, Thijsen A, Hubbard IJ, Francis JL, Grennall C, Levi C, Byles J. Acknowledging How Older Australian Women Experience Life After Stroke: How Does the WHO 18-Item Brief ICF Core Set for Stroke Compare? Health Care Women Int 2015; 36:1311-26. [DOI: 10.1080/07399332.2015.1055747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Han KY, Kim HJ, Bang HJ. Feasibility of Applying the Extended ICF Core Set for Stroke to Clinical Settings in Rehabilitation: A Preliminary Study. Ann Rehabil Med 2015; 39:56-65. [PMID: 25750873 PMCID: PMC4351496 DOI: 10.5535/arm.2015.39.1.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/08/2014] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke. Methods We retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke. Results Clinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component. Conclusion The body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire.
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Affiliation(s)
- Kyu Yong Han
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyo Jong Kim
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Heui Je Bang
- Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Validation of the Comprehensive ICF Core Set for stroke by exploring the patient’s perspective on functioning in everyday life. Int J Rehabil Res 2014; 37:302-10. [DOI: 10.1097/mrr.0000000000000070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Johansson GM, Frykberg GE, Grip H, Broström EW, Häger CK. Assessment of arm movements during gait in stroke - the Arm Posture Score. Gait Posture 2014; 40:549-55. [PMID: 25065628 DOI: 10.1016/j.gaitpost.2014.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 05/22/2014] [Accepted: 06/26/2014] [Indexed: 02/02/2023]
Abstract
The purpose of the study was to apply the Arm Posture Score (APS) to a stroke population, since comprehensive measures to quantify arm swing in the affected and non-affected arms during gait are lacking. A further aim was to investigate how gait speed and upper limb function estimated by clinical measures are related to the APS in the stroke group. The APS is the summarized root mean square deviation (RMSD) from normal, based on kinematics. Four arm movements (sagittal and frontal planes) as well as six arm movements (incorporating transversal plane) were included in the calculation of APS, referred to as APS4 and APS6, respectively. The study population consisted of 25 persons with stroke and 25 age- and gender-matched controls. The APS measures were significantly different between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls (p≤0.001). Spasticity significantly influenced both APS measures, while speed only had a significant effect on the APS4. The APS measures correlated significantly to clinical measures of upper limb function. Both APS measures seem to be useful indices to quantify and discriminate between impaired and normal arm swing during gait after stroke. The variability of rotational arm movements needs to be studied further before considering the additional value of the APS6 over the APS4. When interpreting the APS, complementary kinematics should be taken into account, as the single value of the APS gives no information about the direction of the deviation.
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Affiliation(s)
- Gudrun M Johansson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden.
| | - Gunilla E Frykberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden
| | - Helena Grip
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden
| | - Eva W Broström
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Solna, Q2:07, SE-171 76 Stockholm, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE-901 87 Umeå, Sweden
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Daily life dialogue assessment in psychiatric care-face validity and inter-rater reliability of a tool based on the International Classification of Functioning, Disability and Health. Arch Psychiatr Nurs 2013; 27:306-11. [PMID: 24238011 DOI: 10.1016/j.apnu.2013.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/25/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022]
Abstract
This article describes the development of an assessment tool based on the International Classification of Functioning Disability and Health (ICF) adapted to a psychiatric nursing context where both the patient and the nurse assess the patient's ability to participate in various spheres of life. The aim was to test psychometric properties, focusing on face validity and inter-rater reliability. Three Swedish expert groups participated. Analysis of inter-rater reliability was conducted through simulated patient cases. The results of an unweighted kappa value of 0.38, a linear weighted kappa value of 0.65 and a quadratic weighted kappa value of 0.73 were considered as acceptable when using simulated patient cases.
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Riberto M, Lopes KAT, Chiappetta LM, Lourenção MIP, Battistella LR. The use of the comprehensive International Classification of Functioning, Disability and Health core set for stroke for chronic outpatients in three Brazilian rehabilitation facilities. Disabil Rehabil 2012; 35:367-74. [DOI: 10.3109/09638288.2012.694573] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Poor concurrence between disabilities as described by patients and established assessment tools three months after stroke: A mixed methods approach. J Neurol Sci 2012; 313:160-6. [DOI: 10.1016/j.jns.2011.08.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/24/2011] [Accepted: 08/26/2011] [Indexed: 11/30/2022]
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Chang KH, Chen HC, Lin Y, Chen SC, Chiou HY, Liou TH. Developing an ICF core set for post-stroke disability assessment and verification in Taiwan: a preliminary study. Disabil Rehabil 2011; 34:1254-61. [DOI: 10.3109/09638288.2011.638033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Pedro-Cuesta J, Alberquilla Á, Virués-Ortega J, Carmona M, Alcalde-Cabero E, Bosca G, López-Rodríguez F, García-Sagredo P, García-Olmos L, Salvador CH, Monteagudo JL. ICF disability measured by WHO-DAS II in three community diagnostic groups in Madrid, Spain. GACETA SANITARIA 2011; 25 Suppl 2:21-8. [DOI: 10.1016/j.gaceta.2011.08.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/26/2011] [Accepted: 08/08/2011] [Indexed: 10/14/2022]
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Glässel A, Coenen M, Kollerits B, Cieza A. Validation of the extended ICF core set for stroke from the patient perspective using focus groups. Disabil Rehabil 2011; 34:157-66. [DOI: 10.3109/09638288.2011.593680] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Palmcrantz SM, Holmqvist LW, Sommerfeld DK. Development, validity and reliability of a postal questionnaire assessing health states relevant to young persons with stroke in Sweden. Disabil Rehabil 2011; 33:1179-85. [DOI: 10.3109/09638288.2010.524273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Algurén B, Fridlund B, Cieza A, Sunnerhagen KS, Christensson L. Factors associated with health-related quality of life after stroke: a 1-year prospective cohort study. Neurorehabil Neural Repair 2011; 26:266-74. [PMID: 21825005 DOI: 10.1177/1545968311414204] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In line with patient-centered health care, it is necessary to understand patients' perceptions of health. How stroke survivors perceive their health at different time points after stroke and which factors are associated with these feelings provide important information about relevant rehabilitation targets. OBJECTIVE This study aimed to identify the independent factors of health-related quality of life (HRQoL) from a biopsychosocial perspective using the methods of multivariate regression at 3 different time points poststroke. METHODS Included in the study were 99 patients from stroke units with diagnosed first-ever stroke. At admission and at 6 weeks, 3 months, and 1 year poststroke, HRQoL was assessed using the EuroQoL-5D Visual Analogue Scale (EQ-5D VAS). Consequences in Body Functions and Activities and Participation, and Environmental Factors were documented using 155 categories of the International Classification of Functioning, Disability and Health (ICF) Core Set for Stroke. RESULTS For a period of 1 year, problems with recreation and leisure, personality functions, energy and drive functions, and gait pattern functions were repeatedly associated with worse HRQoL. Whereas Body Functions and Activities and Participation explained more than three-fourths of the variances of HRQoL at 6 weeks and 3 months (R² = 0.80-0.93), the variation at 1 year was best explained by either Body Functions or Environmental Factors (R² = 0.51). CONCLUSIONS The results indicate the importance of Body Functions and Activities and Participation (mainly personality functions and recreation and leisure) on HRQoL within 3 months poststroke, but increased impact of Environmental Factors on HRQoL at 1 year.
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Content validity of the Extended ICF Core Set for stroke: an international Delphi survey of physical therapists. Phys Ther 2011; 91:1211-22. [PMID: 21659466 DOI: 10.2522/ptj.20100262] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The "Extended ICF Core Set for stroke" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of people with stroke. OBJECTIVE The objective of this study was to validate this ICF Core Set from the perspective of physical therapists. DESIGN AND METHODS Physical therapists experienced in stroke intervention were asked about their patients' problems and resources and about aspects of the environment that physical therapists treat in people with stroke in a 3-round electronic-mail survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated using the kappa statistic. RESULTS One hundred twenty-five physical therapists from 24 countries named 4,793 problems treated by physical therapists in people with stroke. They identified 10 second-level ICF categories that currently are not represented in the Extended ICF Core Set for stroke. Twelve responses of the participants were linked to the ICF component personal factors, and 15 responses were not covered by the current version of the classification. The kappa coefficient for the linking agreement was 0.39 (95% bootstrapped confidence interval=0.34-0.41). LIMITATIONS Two World Health Organization regions were not represented in the sample of physical therapists. CONCLUSIONS According to the physical therapists, the current version of the Extended ICF Core Set for stroke largely covers the types of problems that their interventions address. However, some aspects of functioning emerged that are not yet covered and may need further investigation.
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Martins EF, De Sousa PHC, De Araujo Barbosa PHF, De Menezes LT, Souza Costa A. A Brazilian experience to describe functioning and disability profiles provided by combined use of ICD and ICF in chronic stroke patients at home-care. Disabil Rehabil 2011; 33:2064-74. [DOI: 10.3109/09638288.2011.560332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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