Non-motor Factors Associated with the Attainment of Community Ambulation after Stroke

Predicting Recovery of Independent Walking After Stroke: A Systematic Review

ABSTRACT

Patients recovering from a stroke experience reduced participation, especially when they are limited in daily activities involving walking. Understanding the recovery of independent walking, can be used by clinicians in the decision-making process during rehabilitation, resulting in more personalized stroke rehabilitation. Therefore, it is necessary to gain insight in predicting the recovery of independent walking in patients after stroke. This systematic review provided an overview of current evidence about prognostic models and its performance to predict recovery of independent walking after stroke. Therefore, MEDLINE, CINAHL, and Embase were searched for all relevant studies in English and Dutch. Descriptive statistics, study methods, and model performance were extracted and divided into two categories: subacute phase and chronic phase. This resulted in 16 articles that fulfilled all the search criteria, which included 30 prognostic models. Six prognostic models showed an excellent performance (area under the curve value and/or overall accuracy ≥0.90). The model of Smith et al. (2017) showed highest overall accuracy (100%) in predicting independent walking in the subacute phase after stroke ( Neurorehabil Neural Repair 2017;31(10-11):955-64.). Recovery of independent walking can be predicted in the subacute and chronic phase after stroke. However, proper external validation and the applicability in clinical practice of identified prognostic models are still lacking.

Self-reported factors associated with community ambulation after stroke: The Canadian Longitudinal Study on Aging

Community ambulation is frequently limited for people with stroke. It is, however, considered important to people with stroke. The objectives were to identify factors associated with self-reported community ambulation in Canadians aged 45+ with stroke and to identify factors associated with community ambulation specific to Canadian males and to Canadian females with stroke. Data were utilized from the Canadian Longitudinal Study on Aging Tracking Cohort. Multivariate logistic regression models were developed for community ambulation. Mean age was 68 (SE 0.5) years (45% female). In the final community ambulation model (n = 855), factors associated with being less likely to 'walk outdoors sometimes or often' included difficulty or being unable to walk 2-3 blocks (decreased endurance) vs. no difficulty. Being more likely to walk outdoors was associated with 'better weather' months and being 55-64 years of age vs 75-85. Differences were noted between the models of only males and only females. Decreased walking endurance is associated with a decreased likelihood of walking in the community-a factor that can be addressed by rehabilitation professionals and in community based programs.

Gait asymmetry in stroke patients with unilateral spatial neglect

The recovery of independent gait represents one of the main functional goals of the rehabilitative interventions after stroke but it can be hindered by the presence of unilateral spatial neglect (USN). The aim of the paper is to study if the presence of USN in stroke patients affects lower limb gait parameters between the two body sides, differently from what could be expected by the motor impairment alone, and to explore whether USN is associated to specific gait asymmetry. Thirty-five stroke patients (right or left lesion and ischemic or hemorrhagic etiology) who regained independent gait were assessed for global cognitive functioning and USN. All patients underwent a gait analysis session by using a wearable inertial system, kinematic parameters were computed. Enrolled patients presented altered motion parameters. Stroke patients with USN showed specific asymmetries in the following parameters: stance phase, swing phase, and knee range of motion. No differences in the clinical scores were found as the presence of USN. The presence of USN was associated with a specific form of altered gait symmetry. These findings may help clinicians to develop more tailored rehabilitative training to enhance gait efficacy of patients with motor defects complicated by the presence of selected cognitive impairments. Overview of the experiment setup. The workflow shows: diagnosis of unilateral spatial neglect by the neuropsychologist, sensors placement, gait analysis protocol and evaluation of the gait asymmetry together with the statistically significant features.

Using rhythm for rehabilitation: the acceptability of a novel haptic cueing device in extended stroke rehabilitation

Purpose

Restoration of walking ability is a key goal to both stroke survivors and their therapists. However, the intensity and duration of rehabilitation available after stroke can be limited by service constraints, despite the potential for improvement which could reduce health service demands in the long run. The purpose of this paper is to present qualitative findings from a study that explored the acceptability of a haptic device aimed at improving walking as part of an extended intervention in stroke rehabilitation.

Design/methodology/approach

Pre-trial focus groups and post-trial interviews to assess the acceptability of Haptic Bracelets were undertaken with seven stroke survivors.

Findings

Five themes were identified as impacting on the acceptability of the Haptic Bracelet: potential for improving quality of life; relationships with technology; important features; concerns; response to trial and concentration. Participants were interested in the haptic bracelet and hoped it would provide them with more confidence making them: feel safer when walking; have greater ability to take bigger strides rather than little steps; a way to combat mistakes participants reported making due to tiredness and reduced pain in knees and hips.

Originality/value

Haptic Bracelets are an innovative development in the field of rhythmic cueing and stroke rehabilitation. The haptic bracelets also overcome problems encountered with established audio-based cueing, as their use is not affected by external environmental noise.

Peer review

The peer review history for this article is available at: https://publons.com/publon 10.1108/JET-01-2021-0003

The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review

BACKGROUND

Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear.

OBJECTIVES

This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes.

METHODS

PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated.

RESULTS

In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time.

CONCLUSIONS

Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.

Deficits in motor coordination of the paretic lower limb limit the ability to immediately increase walking speed in individuals with chronic stroke

OBJECTIVE

To explore the relationships between clinical measures and the ability to increase walking speed in ambulatory people with chronic stroke and to identify which measures would best predict walking speed reserve.

METHODS

An exploratory, cross-sectional study was conducted with 114 individuals with chronic stroke. The outcome of interest was walking speed reserve, defined as the difference between individuals' comfortable and maximal walking speeds. Predictors were characteristics of the participants (age, sex, time since stroke, relative lower-limb dominance) and motor impairments (tonus, strength, and motor coordination).

RESULTS

The characteristics of the participants did not significantly correlate with walking speed reserve. All measures of motor impairments, i.e., tonus, strength, and motor coordination, were significantly correlated with walking speed reserve (p < 0.01), but only motor coordination was kept in the regression model. Motor coordination alone explained 35% (F = 61.5; p < 0.001) of the variance in walking speed reserve.

CONCLUSIONS

The level of motor coordination of the paretic lower limb is associated with the walking speed reserve of individuals with stroke. Interventions aimed at improving motor coordination may have the potential to improve everyday situations that require immediate increases in walking speed.

Utility of Dynamic Balance Measurements in Discriminating Community Ambulation Levels Among Individuals with Stroke: A Cross-sectional Study

OBJECTIVE

To examine the association between dynamic balance measurements and community ambulation levels among individuals with chronic stroke.

METHODS

This cross-sectional study was performed in 2-day care facilities for older adults located in urban areas. Forty-seven community-dwelling poststroke adults who could walk independently were participated. Community ambulation performance was assessed using the Functional Ambulation Classification of the Hospital at Sagunto (FACHS). Dynamic balance and mobility were measured with the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Timed Up and Go (TUG) test, and 10 m maximum walking speed.

RESULTS

Participants were classified into 3 groups according to FACHS scores: household (n = 15), neighborhood (n = 19), and community walkers (n = 13). Neighborhood and community walkers scored significantly higher on the Mini-BESTest and had a shorter TUG test time than household walkers. Community walkers had a significantly faster walking speed than household walkers, whereas neighborhood walkers did not have a faster walking speed than household walkers. Ordinal logistic regression analyses revealed the Mini-BESTest score (odds ratio [OR] 1.24; 95% confidence interval [CI]: 1.07-1.44) and the TUG test time (OR .91; 95% CI: .85-.98) were significantly associated with ambulation levels after adjusting for confounders.

CONCLUSIONS

Dynamic balance measurement tools may have better responsiveness in detecting community ambulation levels among individuals with chronic stroke than walking speed.

"Connecting patients and therapists remotely using technology is feasible and facilitates exercise adherence after stroke"

Purpose: Repetitive task practice after stroke is important to improve function, yet adherence to exercise is low. The aim of this study was to determine whether using the internet, a tablet application, and a chair sensor that connected to a therapist was feasible in monitoring adherence and progressing a functional exercise at home.Methods: Ten participants with stroke completed a 4-week sit-to-stand exercise using the technology at home (ACTRN12616000051448). A therapist remotely monitored exercise adherence, progressed goals, and provided feedback via the app. Measures of feasibility (design, recruitment/withdrawals, adherence, safety, participant satisfaction and estimates of effect on function) were collected.Results: Participants' mean age was 73.6 years [SD 9.9 years]. The system was feasible to deliver and monitor exercise remotely. All participants completed the study performing a mean 125% of prescribed sessions and 104% of prescribed repetitions. Participants rated the system usability (78%), enjoyment (70%) and system benefit (80%) as high. No adverse events were reported. The mean pre- and post-intervention difference in the total short performance physical battery score was 1.4 (95% CI 0.79, 2.00).Conclusions: It was feasible and safe to prescribe and monitor exercises using an app and sensor-based system. A definitive trial will determine whether such technology could facilitate greater exercise participation after stroke.