Activity In Stroke Survivors Research Articles

Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation: Erratum.

Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation: Erratum.

The feasibility of the adapted H-GRASP program for perceived and actual daily-life upper limb activity in the chronic phase post-stroke

(Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity.Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors.

Alteration in Resting-State Brain Activity in Stroke Survivors After Repetitive Finger Stimulation.

This quasi-experimental study examined the effect of repetitive finger stimulation on brain activation in eight stroke and seven control subjects, measured by quantitative electroencephalogram. We applied 5 mins of 2-Hz repetitive bilateral index finger transcutaneous electrical nerve stimulation and compared differences pre- and post-transcutaneous electrical nerve stimulation using quantitative electroencephalogram metrics delta/alpha ratio and delta-theta/alpha-beta ratio. Between-group differences before and after stimulation were significantly different in the delta/alpha ratio ( z = -2.88, P = 0.0040) and the delta-theta/alpha-beta ratio variables ( z = -3.90 with P < 0.0001). Significant decrease in the delta/alpha ratio and delta-theta/alpha-beta ratio variables after the transcutaneous electrical nerve stimulation was detected only in the stroke group (delta/alpha ratio diff = 3.87, P = 0.0211) (delta-theta/alpha-beta ratio diff = 1.19, P = 0.0074). The decrease in quantitative electroencephalogram metrics in the stroke group may indicate improved brain activity after transcutaneous electrical nerve stimulation. This finding may pave the way for a future novel therapy based on transcutaneous electrical nerve stimulation and quantitative electroencephalogram measures to improve brain recovery after stroke.

Modification of cortical electrical activity in stroke survivors with abnormal subjective visual vertical: An eLORETA study

ObjectivesBalance impairment is among the main complications of stroke. The gravity-based subjective vertical (SV) is considered an important reference for upright posture and navigation affected by stroke. The correlation between injury location and pathological perception of verticality remains controversial. This study aimed to evaluate the cortico-cortical network of vertical perception among patients with the right hemisphere stroke and abnormal visual-vertical perception compared with healthy individuals. Materials and methodsThis observational cross-sectional study included 40 patients with the right hemisphere stroke and 35 healthy participants. All patients had abnormal visual-vertical perception. The EEG connectivity analysis was conducted through the exact low-resolution brain electromagnetic tomography analysis (eLORETA). ResultsStroke survivors manifested a power spectral density that reduced within the beta-2 frequency band in the left hemisphere and increased within the beta-3 frequency band in the right hemisphere compared with controls (p < 0.01). The lagged-phase synchronization was increased within alpha-1, beta-2, and beta-3 bands and decreased in stroke survivors compared with controls in the vestibular network involved in visual-vertical perception (p < 0.01). ConclusionThe results of this study demonstrated variations in the function and functional connectivity of cortical areas involved in the visual-vertical perception that are mainly located in the vestibular cortex.

Relationship between Participation in Daily Life Activities and Physical Activity in Stroke Survivors: A Protocol for a Systematic Review and Meta-Analysis.

Stroke survivors undertake low levels of physical activity and participation in daily life activities, but the correlation between these two domains still carries some degree of uncertainty. This systematic review and meta-analyses-based data synthesis will aim to describe and estimate the relationship between participation in daily life activities and physical activity in stroke survivors. Six databases (MEDLINE/PubMed, Web of Science, Scopus, PEDro, SPORTDiscus, and Rehabilitation & Sport Medicine Source) will be searched. Studies assessing participation alongside physical activity levels in adult stroke survivors in English or Spanish will be included. The study selection, assessment of the risk of bias, and data extraction will be conducted independently by two investigators. If available, correlation values between physical activity and participation outcomes will be extracted. The Hedges-Olkin method will be used for pooling correlation values between participation and physical activity measures. Subgroup analyses will be performed according to the time elapsed since the stroke (i.e., ≤6 months and >6 months). This will be the first systematic review with a meta-analysis to provide information on the relationship between physical activity and participation in stroke survivors. Findings are likely to inform the design of health prevention protocols and the development of healthy behavior change interventions.

Delayed Muscle Activity in Stroke Survivors with Upper-Limb Hemiparesis.

Stroke is the leading cause of disability worldwide, and nearly 80% of stroke survivors suffer from upper-limb hemiparesis. Myoelectric exoskeletons can restore dexterity and independence to stroke survivors with upper-limb hemiparesis. However, the ability of patients to dexterously control myoelectric exoskeletons is limited by an incomplete understanding of the electromyographic (EMG) hallmarks of hemiparesis, such as muscle weakness and spasticity. Here we show that stroke survivors with upper-limb hemiparesis suffer from delayed voluntary muscle contraction and delayed muscle relaxation. We quantified the time constants of EMG activity associated with initiating and terminating voluntary hand grasps and extensions for both the paretic and non-paretic hands of stroke survivors. We found that the initiation and termination time constants were greater on the paretic side for both hand grasps and hand extensions. Notably, the initiation time constant during hand extension was approximately three times longer for the paretic hand than for the contralateral non-paretic hand (0.618 vs 0.189 s). We also show a positive correlation between the initiation and termination time constants and clinical scores on the Modified Ashworth Scale. The difficulty stroke survivors have in efficiently modulating their EMG presents a challenge for appropriate control of assistive myoelectric devices, such as exoskeletons. This work constitutes an important step towards understanding EMG differences after stroke and how to accommodate these EMG differences in assistive myoelectric devices. Real-time quantitative biofeedback of EMG time constants may also have broad implications for guiding rehabilitation and monitoring patient recovery.Clinical Relevance- After a stroke, muscle activity changes, and these changes make it difficult to use muscle activity to drive assistive and rehabilitative technologies. We identified slower muscle contraction and muscle relaxation as a key difference in muscle activity after a stroke. This quantifiable difference in muscle activity can be used to develop better assistive technologies, guide rehabilitation, and monitor patient recovery.

Correlation between physical activity levels and clinical variables in stroke survivors

Increased levels of physical inactivity leads to increased disability level which results to decreased in balance status among stroke survivors. Balance problems are major co-morbidities stroke survivors are posed with. The current study was undertaken to investigate the relationship of physical activity profile and selected clinical variables of stroke survivors ; disability level, balance status and duration of stroke in selected tertiary hospitals in Anambra State, Nigeria. Sixty-eight (68) participants were recruited for this study of which 46 were males and 22 were were females. Physical activity level were measured using a 7-day International Physical Activity Questionnaire-short form (IPAQ-SF), Clinical variables like disability level were measured using Modified Rankin Scale, balance status were measured using Berg Balance Scale. Demographic data were collected which included weight, height, BMI and duration of stroke. The data was tabulated, analyzed statistically and discussed. It was found that physical activity level showed significant positive correlation in clinical variable like balance status, significant negative correlation was found between physical activity level and disability level, also between balance and disability level, non-significant negative correlation was found between physical activity level and duration of stroke incidence. In conclusion, physical activity showed a significant decrease in disability level and balance status. Developing strategies needed to promote and maintain physical activity in stroke survivors as well as potency of physical activity are important to decrease disability level and improve muscle strength adequate enough to maintain balance and good posture. Balance is greatly affected in sitting and high level of disability.

Relationships between overall physical activity and step counts in able-bodied adults and stroke survivors in developing countries: a cross-sectional study

Purpose To investigate how step counts relate to overall physical activity (PA) in able-bodied adults and stroke survivors in developing countries. Materials and methods Sixty able-bodied adults (mean age: 48.8 ± 11.7 years old) and 60 stroke survivors (mean age: 56.7 ± 10.4 years old) were recruited in Benin (West-Africa). Step counts were collected for 7 consecutive days using the Garmin Forerunner 15 activity tracker. Then, participants completed the adapted French version of the International Physical Activity Questionnaire (IPAQ-AF) to report their PA over the same period. Spearman’s rank correlation coefficients (ρ) were calculated between IPAQ-AF scores and the mean steps per day. Results Very high correlations were observed between IPAQ-AF total scores and step counts, in able-bodied adults (ρ = 0.94; p < 0.001), and in stroke survivors (ρ = 0.91; p < 0.001). IPAQ-AF leisure-time presented negligible correlation with step counts in able-bodied adults. No activity was reported in occupation and intense domains in stroke survivors. Conclusion There is a strong relationship between overall PA and step counts in able-bodied adults and stroke survivors in Benin. Step counts appear to be an indicator of PA levels in developing countries, suggesting walking as a potential exercise to improve PA levels in stroke survivors. Implications for Rehabilitation Step counts could serve as an indicator of physical activity levels in stroke survivors in developing countries. Walking may be suggested as exercise to improve physical activity levels in stroke survivors in developing countries. In Africa French speaking countries, the IPAQ-AF could be used to assess physical activity in stroke survivors and findings might guide programs to promote an active lifestyle as needed.

Ambulatory activity in stroke survivors associated with functional outcome and quality of life: An observational cohort study

Physical activity is beneficial in stroke prevention and recovery. Understanding activity dynamics and its effect on outcome after stroke is important to improve recommendations and develop interventions. We examined serial changes in daily ambulatory activity (AA) averaged over 1 week in people with subacute to chronic stroke and its association with functional outcome (modified Rankin scale [mRS]) and quality of life (EQ-5D-3L). This observational study examined AA in stroke survivors with no to moderate disability (US National Institute of Stroke Scale [NIHSS] score) who were mostly community dwelling and had cryptogenic stroke based on data from the Continuous Cardiac Monitoring to Assess Atrial Fibrillation After Cryptogenic Stroke study. The participants underwent long-term AA monitoring by accelerometric activity data obtained from an insertable cardiac monitor without receiving any specific encouragement regarding physical activity. We analysed AA changes and assessed the association between baseline AA and mRS/EQ-5D-3L scores. A small group of participants had follow-up data for 2 years, which allowed for analysing long-term serial changes. We included 186 participants (mean [SD] age 61.3 [11.2] years, 67% male, mean 39 [28] days after stroke). AA increased during the subacute phase in individuals with mild (NIHSS score 1-4, P<0.001) and moderate (NIHSS score 5-10, P=0.013) disability but not in the non-impaired group. Baseline AA was inversely associated with NIHSS score (P<0.001) and was associated with mRS score (P=0.001) and weakly correlated with EQ-5D-3L score at 6 months (P=0.032, r=0.22). For the 45 participants with follow-up data (mean age 64.5 [9.7] years, 80% male, mean 34 [21] days after stroke), AA remained stable. AA increased in stroke survivors with impairments but remained stable in those whose symptoms had resolved. AA during the early subacute period was associated with mRS and EQ-5D-3L scores at 6 months. Insertable cardiac monitoring offers a feasible method for monitoring activity over prolonged periods in people after stroke. Its increased use may offer an opportunity to overcome the limited reliability and validity of many existing measures. ClinicalTrials.gov (NCT00924638).

Determinants of Physical Activity at 90 Days After Acute Stroke or Transient Ischemic Attack in Patients With Home Discharge: A Pilot Study.

The aim was to identify the barriers to achieving premorbid physical activity in patients with home discharge after acute minor stroke or transient ischemic attack. Fifty-six patients (median age, 72years) were analyzed. We assessed total physical activity in the premorbid condition and at 90 days after onset using the International Physical Activity Questionnaire. The patients were divided into two groups according to changes in total physical activity until 90 days after onset: decreased activity (n = 16) and nondecreased activity (n = 40) groups. Outcome measures were examined at discharge. The decreased activity group took significantly longer to perform the timed up and go test (median, 7.19 vs. 6.52s) and contained more apathetic patients (44% vs. 15%). Apathy at discharge (relative risk 6.05, 95% confidence interval [1.33, 27.6]) was a significant determinant of decreased physical activity. Apathy is a barrier to the restoration of premorbid physical activity in stroke survivors.

Association of Health Utility Score with Physical Activity Outcomes in Stroke Survivors.

Health-related quality of life (HRQoL) after stroke tends to vary across studies or across stages of stroke. It is useful to use the health utility score to compare HRQoL across studies. Physical activity after stroke also tends to vary similarly. The purpose of the present study was to determine associations between the health utility score and physical activity outcomes in stroke survivors. This cross-sectional study recruited stroke survivors who could ambulate outside, free of assistance. We assessed the health utility score with the EuroQoL 5-Dimension 3-Level questionnaire. The physical activity outcomes were the number of steps taken and duration of moderate-to-vigorous physical activity (MVPA) as measured with an accelerometer. Multiple linear regression analyses were used to determine whether the physical activity outcomes were independently associated with the health utility score. Fifty patients (age: 68.0 years; 40 men, 10 women) were included. Multiple linear regression analysis showed the health utility score to be significantly associated with the number of steps taken (β = 0.304, p = 0.035) but not with MVPA. This is the first study to examine the association between the health utility score and objectively measured physical activity in stroke survivors. Promoting physical activity especially by increasing the number of steps taken might be a priority goal in improving a patient’s health utility score after stroke.

Precise quantification of the time course of voluntary activation capacity following Botulinum toxin injections in the biceps brachii muscles of chronic stroke survivors

BackgroundSpasticity is a key motor impairment that affects many hemispheric stroke survivors. Intramuscular botulinum toxin (BT) injections are used widely to clinically manage spasticity-related symptoms in stroke survivors by chemically denervating muscle fibers from their associated motor neurons. In this study, we sought to understand how BT affects muscle activation, motor unit composition and voluntary force generating capacity over a time period of 3 months. Our purpose was to characterize the time course of functional changes in voluntary muscle activity in stroke survivors who are undergoing BT therapy as part of their physician-prescribed clinical plan.MethodOur assessment of the effects of BT was based on the quantification of surface electromyogram (sEMG) recordings in the biceps brachii (BB), an upper arm muscle and of voluntary contraction force. We report here on voluntary force and sEMG responses during isometric elbow contractions across consecutive recording sessions, spread over 12 weeks in three segments, starting with a preliminary session performed just prior to the BT injection. At predetermined time points, we conducted additional clinical assessments and we also recorded from the contralateral limbs of our stroke cohort. Eight subjects were studied for approximately 86 experimental recording sessions on both stroke-affected and contralateral sides.ResultsWe recorded an initial reduction in force and sEMG in all subjects, followed by a trajectory with a progressive return to baseline over a maximum of 12 weeks, although the minimum sEMG and minimum force were not always recorded at the same time point. Three participants were able to complete only one to two segments. Slope values of the sEMG-force relations were also found to vary across the different time segments. While sEMG-force slopes provide assessments of force generation capacity of the BT injected muscle, amplitude histograms from novel sEMG recordings during the voluntary tasks provide additional insights about differential actions of BT on the overall motor unit (MU) population over time.ConclusionsThe results of our study indicate that there are potential short term as well as long term decrements in muscle control and activation properties after BT administration on the affected side of chronic stroke survivors. Muscle activation levels as recorded using sEMG, did not routinely return to baseline even at three months’ post injection. The concurrent clinical measures also did not follow the same time course, nor did they provide the same resolution as our experimental measures. It follows that even 12 weeks after intramuscular BT injections muscle recovery may not be complete, and may thereby contribute to pre-existing paresis.

Investigating the performance of an amplitude-independent algorithm for detecting the hand muscle activity of stroke survivors

To make robotic hand devices controlled by surface electromyography (sEMG) signals feasible and practical tools for assisting patients with hand impairments, the problems that prevent these devices from being widely used have to be overcome. The most significant problem is the involuntary amplitude variation of the sEMG signals due to the movement of electrodes during forearm motion. Moreover, for patients who have had a stroke or another neurological disease, the muscle activity of the impaired hand is weak and has a low signal-to-noise ratio (SNR). Thus, muscle activity detection methods intended for controlling robotic hand devices should not depend mainly on the amplitude characteristics of the sEMG signal in the detection process, and they need to be more reliable for sEMG signals that have a low SNR. Since amplitude-independent muscle activity detection methods meet these requirements, this paper investigates the performance of such a method on people who have had a stroke in terms of the detection of weak muscle activity and resistance to false alarms caused by the involuntary amplitude variation of sEMG signals; these two parameters are very important for achieving the reliable control of robotic hand devices intended for people with disabilities. A comparison between the performance of an amplitude-independent muscle activity detection algorithm and three amplitude-dependent algorithms was conducted by using sEMG signals recorded from six hemiparesis stroke survivors and from six healthy subjects. The results showed that the amplitude-independent algorithm performed better in terms of detecting weak muscle activity and resisting false alarms.

Levels and patterns of physical activity in stroke survivors with different ambulation status living in low-income areas of Cape Town, South Africa

ABSTRACT Background: Little is known about physical activity (PA) in people with stroke living in low-income areas. The aim of this study was to characterize and contrast the levels and patterns of PA between stroke survivors with different ambulation status living in low-income areas in Cape Town, South Africa. Methods: In this cross-sectional study, 45 community-dwelling stroke survivors living in low-income areas in Cape Town participated. Accelerometers (Actigraph wGT3X-BT) were used to assess PA levels (vector magnitude counts and number of steps) and time spent sedentary, in light and moderate-to-vigorous PA (MVPA). Total daily PA and within-day activity patterns were compared between limited community ambulators (gait speed: <0.8 m/s) and community ambulators (gait speed: ≥0.8 m/s). Results: Limited community ambulators (n = 23) took fewer steps per day (1091 vs. 3524 steps, P < .001), spent more time sedentary (80% vs 68%, P = .002) and less time in light PA (18% vs 25%, P = .008) and MVPA (1% vs 5%, P < .001) than community ambulators (n = 22). The limited ambulation group had a consistent pattern of PA across the day without any significant variations in PA levels or intensity, whereas the unlimited ambulating group was most active in the morning followed by a gradual reduction in PA throughout the day. Conclusions: Community ambulating stroke survivors showed greater PA levels and a more variable diurnal pattern in contrast to the limited ambulation group. Different interventions may be required to assist the different groups to start engaging in health-enhancing PA.

Abstract P257: Obesity and Diabetes are Jointly Associated With Low Fruit and Vegetable Consumption and Low Physical Activity in Adults With Stroke

Introduction: Engaging in unhealthy behaviors (poor diet, insufficient physical activity) increases risk for recurrent stroke, and can be compounded by obesity and diabetes. Although engaging in healthy behaviors is recommended for managing chronic conditions, the joint association of obesity and diabetes with diet and physical activity in stroke survivors is unknown. Purpose: To compare prevalences of low fruit and vegetable consumption (Low_FV, &lt;1 fruit and &lt;1 vegetable daily), low physical activity (Low_PA, &lt;150 minutes of weekly moderate-intensity physical activity), and both Low_FV and Low_PA (Low_FV&amp;PA) in stroke survivors, stratified by obesity-diabetes status (neither condition, obesity only, diabetes only, obesity &amp; diabetes). Methods: Cross-sectional data from 32,876 noninstitutionalized, U.S. stroke survivors aged ≥45 years from the 2015 and 2017 Behavioral Risk Factor Surveillance System were examined. Weighted, age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for age, sex, race, income, education, and marital status) and 95% CIs were calculated. Results: Prevalences and AORs are displayed in the Table. Prevalences of Low_FV and Low_PA exceeded 50% across obesity-diabetes groups. Prevalences were highest in respondents with obesity &amp; diabetes and lowest in respondents with neither condition across outcome variables. Compared to respondents with neither condition, odds for Low_PA were increased for respondents with obesity &amp; diabetes and obesity only; odds for Low_FV&amp;PA were increased only for respondents with obesity &amp; diabetes. Conclusions: Our results indicated a joint effect of obesity and diabetes with Low_PA and Low_FV&amp;PA, placing stroke survivors with both chronic conditions at greatest risk for not engaging in protective health behaviors. Regardless of obesity-diabetes status, Low_FV and Low_PA exceeded 50%. Targeted interventions that modify these unhealthy behaviors should be explored for decreasing recurrent stroke risk among stroke survivors.

Cerebral Contribution to the Execution, But Not Recalibration, of Motor Commands in a Novel Walking Environment.

Human movements are flexible as they continuously adapt to changes in the environment. The recalibration of corrective responses to sustained perturbations (e.g., constant force) altering one’s movement contributes to this flexibility. We asked whether the recalibration of corrective actions involve cerebral structures using stroke as a disease model. We characterized changes in muscle activity in stroke survivors and control subjects before, during, and after walking on a split-belt treadmill moving the legs at different speeds. The recalibration of corrective muscle activity was comparable between stroke survivors and control subjects, which was unexpected given the known deficits in feedback responses poststroke. Also, the intact recalibration in stroke survivors contrasted their limited ability to adjust their muscle activity during steady-state split-belt walking. Our results suggest that the recalibration and execution of motor commands are partially dissociable: cerebral lesions interfere with the execution, but not the recalibration, of motor commands on novel movement demands.

Exploring the perspectives of stroke survivors and healthcare professionals on the use of mobile health to promote physical activity: A qualitative study protocol

Background: Physical inactivity is both the second-highest population attributable risk factor for and a common consequence of stroke. Despite well-documented health benefits associated with physical activity, its levels typically remain below recommended guidelines in stroke survivors. Consequently, calls have been made for novel interventions targeting the promotion of physical activity in stroke survivors. Mobile health is an emerging field which can offer personalised health interventions through mobile and wireless technology. However, a paucity of research has focused on mobile health to promote physical activity in stroke survivors and, more broadly, this field has been criticised for not incorporating the views of stakeholders. This study aims to explore the perspectives of stroke survivors and healthcare professionals on the development of a mobile health intervention for the promotion of physical activity. Methods: The current study will employ a qualitative descriptive approach using separate, semi-structured focus groups for two key stakeholder groups. Community-dwelling stroke survivors will be recruited through an early supported discharge service for acute stroke and stroke support groups. Healthcare professionals will be recruited through the same early supported discharge service, relevant professional bodies and Twitter. The final number of focus groups will depend on data saturation. Thematic analysis will be conducted using NVivo 12 and findings will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies. Conclusion: This study was granted ethical approval from the HSE Mid-Western Regional Hospital Research Ethics Committee and the Faculty of Education and Health Sciences Research Ethics Committee at the University of Limerick. Output will consist of recommendations for the development of a mobile health intervention aimed at the promotion of physical activity in stroke survivors. Findings will be disseminated locally through presentations at stroke support groups, as well as internationally through academic conferences and peer-reviewed journals.

Supervised exercise delivered via telehealth in real time to manage chronic conditions in adults: a protocol for a scoping review to inform future research in stroke survivors

IntroductionIncreasing physical activity reduces secondary stroke risk factors, but many stroke survivors have low levels of physical activity. Supervised exercise delivered via telehealth has the potential to overcome barriers to...

Relationship between Post-Stroke Cognitive Impairment and Functional Activity of Stroke Survivors in Maiduguri, Borno State Nigeria

Stroke survivors often experience serious cognitive impairment which may impact on their functional activity and the ability to lead an independent life. However, there is paucity of information on the relationship between post-stroke cognitive impairment (PSCI) and functional activity of Nigerian stroke survivors. This study therefore examined the relationship between post-stroke cognitive impairment (PSCI) and functional activity of stroke survivors attending physiotherapy clinics in Maiduguri, north-eastern Nigeria. A cross sectional study design was utilized and a purposive sampling technique was used to recruit participants for this study. One hundred stroke patients from Physiotherapy clinics in Maiduguri, north-eastern Nigeria participated in this study. Data forms were used to obtain information on socio-demographic and clinical characteristics of the participants while Mini-Mental State Examination (MMSE) and Barthel Index (BI) scale were used to obtain information on cognitive impairment and functional activity of the participants respectively. Descriptive statistics of mean, standard deviation, frequency and percentages were used to summarise the socio-demographic and clinical characteristics of the participants. Spearman’s Rank Order Correlation was used to investigate the relationship between PSCI and overall functional activity of the participants on one hand and between PSCI and components of functional activity of the participants. Out of the 100 stroke survivors that participated in the study, 55% were male while 45% were female. The mean age and post-stroke duration of the participants were 55.16 ± 10.01 years and 9.90 ± 10.07 months respectively. The results showed that a positive and significant relationship existed between PSCI and overall functional activity of the participants (r = 0.55, p = 0.00). Similarly, there was a significant and positive correlation between PSCI and the components of functional activity except with the bowel control component of functional activity. The correlations were varied with the highest correlation observed between PSCI and mobility component (r = 0.58, p = 0.001) while the lowest correlation was between PSCI and the bowel control component (r = 0.17, p= 0.10). the correlation coefficient for the other components namely the feeding, bathing, grooming, dressing, bladder control, toilet use, transfer and stair climbing were 0.40, 0.45, 0.40, 0.41, 0.39, 0.44, 0.50 and 0.53 respectively. The outcome of this study showed that the relationship between PSCI and functional activity of the stroke survivors was significant and positive. Furthermore, correlation was highest between PSCI and mobility component of functional activity. It is concluded that reducing PSCI could positively impact on the functional activity of stroke survivors, and enhancing functional activity could also reduce Post-Stroke Cognitive Impairment (PSCI) and therefore Physiotherapists should endeavor to assess cognitive impairment among stroke patients and incorporate treatment strategies that will enhance functional outcome.

Walking activity in community-dwelling stroke survivors within 1 month after discharge from a rehabilitation setting

Objective: To characterize the pattern of activity accumulation in stroke survivors.Method: Nineteen stroke patients and 19 age–sex-matched healthy adults participated. Step counts were measured using a step activity monitor for 3 d. The steps per day, bouts per day, walking time per day, average steps per bout, and average walking time per bout were calculated in each walking-distance category (short, medium, and long-distance bout) and in total.Results: The total steps per day were 8446 and 11,749 steps in stroke survivors and control participants, respectively. The total steps per day and the total bouts per day for the stroke group were both significantly lower compared with the control group. Significant group differences were found in only the medium-distance range. No significant differences were found in average steps per bout.Conclusion: Fewer number of bouts is a characteristic pattern of walking activity in stroke survivors. In particular, a low number of medium-distance bouts in stroke survivors results in a low number of daily steps when compared with healthy adults. To facilitate physical activity in stroke survivors, not only the total number of bouts per day but the number of bouts of varying lengths must be considered. Implications for rehabilitationFewer number of bouts is a characteristic pattern of walking activity in stroke survivors.Low number of bouts, especially medium-distance bouts, in stroke survivors, results in low number of daily steps when compared with healthy adults.The number of long-distance bouts is important for increasing total daily steps after stroke with mild disability.To facilitate physical activity in stroke survivors, not only the total number of bouts per day but the number of bouts of varying lengths must be considered.