Community-dwelling Chronic Stroke Survivors Research Articles

Remote delivered cognitive rehabilitation programs in Acquired Brain Injury: a systematic review of methods and outcomes

AbstractRemote delivered cognitive rehabilitation programs (r-CRP) are increasingly recognized as alternative and complementary intervention approaches to traditional cognitive rehabilitation (CR) in the context of several neurological conditions, including acquired brain injuries (ABI). This systematic review examines the methodological characteristics of currently available r-CRP for ABI patients and investigates their impact on cognitive and noncognitive outcomes. A systematic search was performed on EBSCOhost, PubMed, and Web of Science, complemented by a manual search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Collaboration Guidelines were followed. Out of 1624 studies, a total of 19 studies were included. The results demonstrate that most r-CRP were administered to middle-aged community-dwelling chronic stroke survivors and that there was no consensus regarding assessment and intervention protocols. Moreover, most r-CRP were delivered through information and communication technologies (ICTs), primarily relying on cognitive training (CT) interventions addressing multiple cognitive domains (e.g., attention, memory). These ICT-based CT programs included tasks with low ecological validity, i.e., tasks with limited real-world application (e.g., cancelation tasks with artificial stimuli), and were asynchronous, meaning that participants performed the sessions at their own pace, without real-time monitoring from a therapist. In terms of the impact of r-CRP, class I studies reported mixed and inconsistent results regarding the effect of this mode of delivery on cognitive and noncognitive outcomes of ABI patients while supporting its high feasibility and acceptability among patients. Specific recommendations for future research are provided to improve the methodological quality of clinical studies and establish the evidence base for r-CRP.

PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke-a methodological paper with an application example.

Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the "Framework for Developing and Evaluating Complex Interventions" by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2-3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.

Relationship between trunk control, core muscle strength and balance confidence in community-dwelling patients with chronic stroke

ABSTRACT Background and objective Impaired trunk control and core muscle weakness affect balance capacity after stroke, but confirmatory literature is lacking. The objective was to examine the relationship between trunk control, core muscle strength and self-confidence on balance efficacy in community-dwelling chronic stroke survivors and to identify trunk performance measures for determining balance confidence. Methods Patients with a median post-stroke duration of 12 (IQR 7–18) months and independent walking ability participated in this cross-sectional study. Trunk control, core muscle strength and balance confidence were measured using trunk impairment scale 2.0 (TIS 2.0), handheld dynamometer and activity-specific balance confidence scale, respectively. Correlation among TIS 2.0, core muscle strength and balance confidence were tested by Pearson’s correlation coefficient. Stepwise multivariate linear regression analysis was conducted to examine the most important trunk performance variables determining balance confidence. Results Of 177 study participants, the median (IQR) score for TIS 2.0 was 10 (7–12) out of 16 and for balance confidence 41 (27–61) out of 100. Trunk control was highly correlated to overall core muscles strength (r = 0.61–0.70, p <.001) and balance confidence (r = 0.66, p <.001). The major trunk determinants of balance confidence were TIS 2.0 total score (partial R2 = 0.433) and dynamic sitting balance, i.e. trunk lateral flexion (partial R2 = 0.376) in chronic stroke. Conclusion A significant and strong positive association exists among trunk control, core muscles strength and balance confidence in community-dwelling patients with chronic stroke, warranting further investigation of the effect of targeted trunk rehabilitation strategies on functional balance.

The reliability and validity of the Survey of Activities and Fear of Falling in the Elderly for assessing fear and activity avoidance among stroke survivors.

IntroductionActivity restriction due to fear of falling is a common problem after a stroke. It can lead to deteriorated physical condition, restricted social participation and deprived quality of life. The Survey of Activities and Fear of Falling in the Elderly (SAFE) was developed to assess these difficulties, and its utility has been demonstrated among the older adults and older people with Parkinson’s disease. This study aimed to expand those demonstrations to community-dwelling chronic stroke survivors using a Chinese translation of the instrument.MethodsOne hundred and eight elderly individuals with a history of stroke completed the Chinese version of the SAFE (SAFE-C). The internal consistency of their responses was assessed using Cronbach’s alpha. Twenty of the same subjects were reassessed after a 1-week interval to assess the instrument’s test-retest reliability. Structure validity was examined by exploratory factor analysis. Pearson correlation was used to establish the instrument’s convergent validity with respect to the results from the Chinese version of the Activities-specific Balance Confidence Scale (ABC-C) and the Chinese version of the Lawton Instrumental Activities of Daily Living scale (IADL-C).ResultsThe items of the SAFE-C demonstrated excellent internal consistency with a Cronbach’s alphas of 0.90. The SAFE-C also had excellent test-retest reliability with an overall intra-class correlaton coefficient of 0.91. A 1-factor structure termed “fear avoidance circumstances” was identified and it was shown to be consistent with the original measure developed among community-living older people. The correlations between the SAFE-C and the ABC-C (r = -0.68) and the IADL-C (r = -0.57) confirmed the convergent validity.ConclusionsFear avoidance behavior is a homogeneous construct applicable to people with stroke-specific impairments alike. The SAFE-C is a reliable and valid instrument for measuring the level of fear avoidance behavior among community-dwelling stroke survivors. Stroke survivors with good functional mobility revealed a low level of fear and avoidance as measured by the SAFE-C.

Influence of Chronic Stroke on Functional Arm Reaching: Quantifying Deficits in the Ipsilesional Upper Extremity.

Purpose The purpose of this study was to quantify ipsilesional upper extremity (UE) stand-reaching performance (kinematics and kinetics) among chronic stroke survivors. Method Community-dwelling chronic stroke survivors (n=13) and age-similar healthy adults (n=13) performed flexion- and abduction-reaching tasks. Surface EMG and acceleration were sampled using wireless sensors from the prime movers (anterior and middle deltoid) and provided performance-outcome (reaction time, burst duration, movement time, and movement initiation time) and performance-production (peak acceleration) measures and were then evaluated. Results Individuals with chronic stroke demonstrated significantly reduced performance outcomes (i.e., longer reaction time, burst duration, movement time, and movement initiation time) and performance production ability (i.e., smaller peak acceleration) compared to their healthy counterparts (p < 0.05) for both flexion- and abduction-reaching movements. Conclusion Our results are suggestive of post-stroke deficits in ipsilesional motor execution during a stand-reaching task. Based on these findings, it is essential to integrate ipsilesional UE training into rehabilitation interventions as this might aid functional reaching activities of daily living and could ultimately help community-dwelling chronic stroke survivors maintain their independent living.

An investigation of the psychometric properties of the Chinese (Cantonese) version of Subjective Index of Physical and Social Outcome (SIPSO)

Objective: The objectives of this study were 1) to translate and make cultural adaptations to the English version of the SIPSO questionnaire to create a Chinese (Cantonese) version, 2) evaluate the internal consistency, test-retest reliability the C-SIPSO questionnaire, and 3) compare the SIPSO-C scores of stroke survivors with different demographic characteristics to establish the discriminant validity of the questionnaire Design: Translation of questionnaire, cross sectional study. Setting: University-based clinical research laboratory. Subjects Community-dwelling chronic stroke survivors. Interventions: Not applicable. Main measures: Subjective Index of Physical and Social Outcome, Geriatric Depression Scale, 10-metre Walk test. Results: Two bilingual professional translators translated the SIPSO questionnaire independently. An expert panel comprising five registered physiotherapists verified the content validity of the final version (C-SIPSO). C-SIPSO demonstrated good internal consistency (Cronbach’s α = 0.83) and excellent test-retest reliability (ICC3,1 = 0.866) in ninety-two community dwelling chronic stroke survivors. Stroke survivors scored higher than 10 in the Geriatric Depression Scale (U = 555.0, P < 0.001) and with the comfortable walking speed lower than 0.8ms–1 (U = 726.5; P = 0.012) scored significantly lower on SIPSO-C. Conclusion: SIPSO-C is a reliable instrument that can be used to measure the level of community integration in community-dwelling stroke survivors in Hong Kong and southern China. Stroke survivors who were at high risk of minor depression and with limited community ambulation ability demonstrated a lower level of community integration as measured with SIPSO-C

Relationship between Pelvic Alignment and Weight-bearing Asymmetry in Community-dwelling Chronic Stroke Survivors.

Background and Purpose:Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors.Materials and Methods:This cross-sectional study was conducted in tertiary care rehabilitation centers. In standing, the lateral and anterior pelvic tilt angle of chronic stroke survivors was assessed using palpation (PALM™) meter device. The percentage of WBA was measured with two standard weighing scales. Pearson correlation coefficient (r) was used to study the correlation between pelvic tilt and WBA.Results:Of 112 study participants, the mean (standard deviation) age was 54.7 (11.7) years and the poststroke duration was 14 (11) months. The lateral pelvic tilt on the most affected side and bilateral anterior pelvic tilt were 2.47 (1.8) and 4.4 (1.8) degree, respectively. The percentage of WBA was 23.2 (18.94). There was a high correlation of lateral pelvic tilt with WBA (r = 0.631; P < 0.001) than anterior pelvic tilt (r = 0.44; P < 0.001).Conclusion:Excessive lateral pelvic tilt toward the most affected side in standing may influence the weight-bearing ability of the ipsilateral lower extremity in community-dwelling chronic stroke survivors.

Virtual Reality-Based Dance Gaming Improves Performance on an Instrumented Functional Arm Reach Task in Community-Dwelling Chronic Stroke Survivors

Virtual Reality-Based Dance Gaming Improves Performance on an Instrumented Functional Arm Reach Task in Community-Dwelling Chronic Stroke Survivors

Monitoring Step Activity During Task-Oriented Circuit Training in High-Functioning Chronic Stroke Survivors: A Proof-of-Concept Feasibility Study.

ObjectiveTo explore the amount of practice and progression during task-oriented circuit training (TOCT) in chronic stroke survivors; to test the use of pedometers and observation-based measures in detecting step activity; to verify the possible correlation between step activity and locomotor function improvements.MethodsSix community-dwelling chronic stroke survivors underwent 10 TOCT sessions (2 hours/each) over 2 weeks in which they were trained both on a treadmill and on six task-oriented workstations (W1–W6). During the sessions, they wore a piezoelectric pedometer and step activities were recorded. Outcome measures were as follows: % of activities during which pedometers worked properly; pedometer-based measures (total step counts, treadmill steps, workstation steps—total and W2,W3,W5,W6); observation-based measures (number of repetitions in task W1 and W4); walking speed changes measured by the 10-m walking test (10MWT) and walking endurance changes (6-minute walking test) after TOCT.ResultsDuring TOCT sessions (n=57), activities were recorded through pedometer-based measures in 4 out of the 6 patients. The total amount of step activity was 5,980.05±1,968.39 steps (54.29% in task-oriented workstations, 37.67% on treadmill, and 8.03% during breaks). Exercise progression was highlighted significantly by observational measures (W1, W4). A positive correlation was observed between increased gait speed and observational stair step repetitions progression (W1) (r=0.91, p=0.01) or pedometer-based tandem exercise step progression (W3) (r=0.98, p=0.01).ConclusionTOCT can be considered a high-intensity, progressive intervention to restore locomotor function in chronic stroke survivors. Pedometer-based measures might help in quantifying TOCT's volume of practice; however, further investigations are required.

Cross-cultural validity of the Brazilian version of the ABILHAND questionnaire for chronic stroke individuals, based on Rasch analysis.

To evaluate the cross-cultural validity of the Brazilian version of the ABILHAND for stroke individuals. A total of 107 community-dwelling chronic stroke survivors; mean age 58 years. Cross-cultural adaptation of the ABILHAND followed standardized procedures. Measurement properties of the adapted version were analysed using Rasch analysis. Cross-cultural validity was based on cultural invariance analyses. The ABILHAND-Brazil demonstrated satisfactory performance as a rating scale. Only one item exhibited misfit to the Rasch model expectations. Principal component analysis of the residuals showed that the manual ability of the individuals encompassed different contents related to the degree of the paretic upper limb involvement in performing manual activities. Some minor local dependency was identified in 2 pairs of items (residual correlations > 0.3). Furthermore, the adapted version exhibited high levels of reliability, no floor effects, and minimal ceiling effect. Analyses of cultural invariance showed that the ABILHAND-Original and ABILHAND-Brazil calibrations can be used interchangeably. The ABILHAND specific for stroke individuals demonstrated satisfactory measurement properties for use within both clinical and research contexts in Brazil, and cross-cultural validity for use in international/multicentric studies between Brazil, Belgium, and Italy.

Exercise Training and Recreational Activities to Promote Executive Functions in Chronic Stroke: A Proof-of-concept Study

Stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. Both exercise and recreational activities are promising strategies. We assessed the effect of a 6-month exercise and recreation program on executive functions in adults with chronic stroke. A 6-month ancillary study within a multicentre randomized trial. Twenty-eight chronic stroke survivors (ie, ≥ 12 months since an index stroke) were randomized to 1 of 2 experimental groups: intervention (INT; n = 12) or delayed intervention (D-INT; n = 16). Participants of the INT group received a 6-month community-based structured program that included 2 sessions of exercise training and 1 session of recreation and leisure activities per week. Participants of the D-INT group received usual care. The primary outcome measure was the Stroop Test, a cognitive test of selective attention and conflict resolution. Secondary cognitive measures included set shifting and working memory. Mood, functional capacity, and general balance and mobility were additional secondary outcome measures. Compared with the D-INT group, the INT group significantly improved selective attention and conflict resolution (P = .02), working memory (P = .04), and functional capacity (P = .02) at the end of the 6-month intervention period. Improved selective attention and conflict resolution was significantly associated with functional capacity at 6 months (r = .39; P = .04). This is the first randomized study to demonstrate that an exercise and recreation program can significantly benefit executive functions in community-dwelling chronic stroke survivors who are mildly cognitively impaired-a population at high-risk for dementia and functional decline. Thus, clinicians should consider prescribing exercise and recreational activities in the cognitive rehabilitation of chronic stroke survivors.

Task Matters: Influence of Different Cognitive Tasks on Cognitive-Motor Interference During Dual-Task Walking in Chronic Stroke Survivors

Background: The impact of unilateral brain damage, such as that caused by stroke, on the interaction between higher cognitive functions and walking remains uncertain. We compared cognitive-motor interference (CMI) during dual-task (DT) walking between chronic stroke survivors and young adults performing explicitly different cognitive tasks. Methods: Ten community-dwelling chronic stroke survivors and 10 young adults performed 3 cognitive tasks – visuomotor reaction time (VMRT), serial subtraction (SS), and Stroop test (STR) – while sitting and walking. Gait velocity was recorded using an electronic walkway. Cognitive variables included reaction time and number of correct responses. Motor and cognitive costs were computed. Results: DT walking led to significant declines in motor and cognitive performance. Significant main effect of task (P < .01) and group (P < .01) was observed for motor cost. The stroke group showed highest motor cost for SS task, whereas the young group showed highest motor cost for STR task (Group × Task interaction, P < .05). Although cognitive costs for both groups was highest for VMRT and lowest for STR tasks, cognitive cost for SS task was significantly greater for the stroke group compared with the young group (Group × Task interaction, P < .05). Conclusions: CMI pattern in chronic stroke survivors differs significantly with type of cognitive task. Gradual cognitive decline with chronicity of condition might have a role in altering the CMI pattern in this population. Future studies of DT interventions for stroke survivors might benefit from incorporating working memory tasks in their protocols.

‘Masterstroke: a pilot group stroke prevention program for community dwelling stroke survivors’

Objectives: To explore whether a pilot secondary stroke prevention group program for community-dwelling chronic stroke survivors assisted participants in modifying their lifestyle to reduce their risk of secondary stroke. Design: A mixed methods study (quantitative and qualitative). Setting: Community. Subjects: Twenty-two community dwelling, chronic stroke survivors. Intervention: The Masterstroke program incorporated a secondary prevention stroke group program over a 9-week period with two 2-h sessions weekly (1 hour for education and 1 hour for exercise). The exercise component incorporated fitness, strength, mobility and balance and education focused on secondary stroke prevention whilst also providing chronic condition self-management support. Main measures: Timed Up and Go (TUG), Six Minute Walk Test (6MWT), Fat and Fibre Barometer, The Stroke and Aphasia Quality of Life Scale (SaQoL-39), and questionnaires for salt intake and stroke knowledge. Qualitative outcomes were participants’ perceptions. Data analysis involved an inductive thematic approach with constant comparison. Results: There were insufficient participants for results to reach statistical significance in all categories, however, statistically significant results where achieved with regards to knowledge, TUG, salt intake and quality of life (QoL) scores. Qualitative responses explored participants’ experience of the Masterstroke program; results confirmed increases in knowledge about stroke and exercise tolerance, successfulness of a group program and lifestyle modification post stroke. Conclusions: Participation in the Masterstroke program for community dwelling stroke survivors resulted in significant improvements in knowledge, functional balance, dietary behaviours and quality of life. Qualitative interviews support the participants’ implementation of lifestyle changes essential for reducing risks of secondary stroke. Results support the utilisation of this model and warrants rigorous investigation regarding long-term impacts of an education and exercise program on community dwelling stroke survivors.Implications for RehabilitationA program which incorporates exercise and education in a group setting may improve health-related quality of life and functional performance for community dwelling, chronic stroke survivors.It is feasible for a multidisciplinary team to implement a secondary stroke prevention group program for community dwelling, chronic stroke survivors.

Effect of Intensive Rehabilitation on Physical Function and Arterial Function in Community-Dwelling Chronic Stroke Survivors

Background: Atherothrombosis due to arteriosclerosis is a risk factor for recurrence of stroke. Although exercise therapy is essential to prevent progression of arteriosclerosis and to improve endothelial function, little is known about the effect of rehabilitation in chronic stroke survivors. Objective: The purpose of this study was to investigate the effect of intensive rehabilitation on physical and arterial function among community-dwelling stroke survivors. Methods: Forty-four community-dwelling stroke survivors participated in the study. The experimental group (n = 22) received primarily intensive strengthening exercise and the control group (n = 22) received standard physical therapy consisting mainly of stretching and gait training. Both groups underwent the rehabilitation program for 12 weeks. Physical function was evaluated using 10-m gait velocity, the 30-s chair stand test, Timed Up and Go test, and grip strength. Arterial function of the affected and unaffected sides was evaluated using the cardio-ankle vascular index (CAVI) as an index of arterial stiffness and the ankle-brachial pressure index (ABI) as an index of arterial occlusion. Results: After the 12-week rehabilitation period, improvement in physical function did not differ between the 2 groups; whereas with regard to arterial function, a significant improvement in the CAVI for the affected side was observed in the experimental group (P < .001). Also, the ABI for the unaffected side in the experimental group was significantly improved after intervention (P < .001). No significant differences were found for the unaffected-side CAVI and affected-side ABI between the 2 groups. Conclusions: These findings suggested that intensive rehabilitation for stroke patients during the chronic stage preserved physical function and improved arterial function.

An initial exploration of the perceptual threshold test using electrical stimulation to measure arm sensation following stroke

Objective: To explore the viability of the perceptual threshold test using electrical stimulation to measure light touch sensation in the hands of stroke survivors. Design: Descriptive study. Setting: University research laboratory. Subjects: Twenty-nine adult community-dwelling chronic stroke survivors. Main measure(s): Perceptual threshold test using electrical stimulation, stroke rehabilitation assessment of movement, Nottingham sensory assessment for stereognosis, action research arm test, Fugl-Meyer assessment of sensation and motor activity log 14. Results: Perceptual threshold test using electrical stimulation mean threshold values were 1.23 (0.6) milliamperes (range 0.5–3.5) for the uninvolved side and 1.68 (0.91) milliamperes (range 0.5–4.5) for the involved side. The perceptual threshold test using electrical stimulation demonstrated excellent intra-rater reliability (intraclass correlation coefficient = 0.896 – uninvolved; 0.829 – involved). There was a statistically significant difference between the perceptual threshold test using electrical stimulation mean threshold values for the uninvolved and involved arms (P = 0.003), but this significance did not hold for subjects who had normal sensation as measured by the Fugl-Meyer assessment of sensation (P = 0.083). Low to nonexistent correlations were found between the perceptual threshold test using electrical stimulation and other measures of sensation, arm movement, activity and participation. Conclusions: The perceptual threshold test using electrical stimulation is a reliable and clinically feasible test with the potential to identify sensory capacity in stroke survivors with substantial sensory loss. Electrical sensory thresholds do not reflect overall sensory function or motor capabilities in stroke survivors.

A multidisciplinary group programme in rural settings for community-dwelling chronic stroke survivors and their carers: a pilot randomized controlled trial

Objectives: To explore whether a group programme for community-dwelling chronic stroke survivors and their carers is feasible in rural settings; to measure the impact of the programme on health-related quality of life and functional performance; and to determine if any benefits gained are maintained. Design: Randomized, assessor blind, cross-over, controlled trial. Setting: Rural outpatient. Subjects: Twenty-five community-dwelling, chronic stroke survivors and 17 carers of participant stroke survivors. Intervention: The intervention group undertook a once-a-week, seven-week group programme combining physical activity, education, self-management principles and a ‘healthy options’ morning tea. At completion, the control group crossed over to receive the intervention. Main measures: Stroke Impact Scale (stroke survivors), Health Impact Scale (carers), Six Minute Walk Test, Timed Up and Go, Caregiver Strain Index. Results: There were insufficient participants for results to reach statistical significance. However between-group trends favoured the intervention group in the majority of outcome measures for stroke survivors and carers. The majority of measures remained above baseline at 12 weeks post programme for stroke survivor participants. The programme was well attended. Of the seven sessions all participants attended four or more and 88% attended six or seven sessions. Conclusions: This novel programme incorporating physical activity, education and social interaction proved feasible to undertake by a stroke-specific multidisciplinary team in three rural Australian settings. This programme may improve and maintain health-related quality of life and physical functioning for chronic stroke survivors and their carers and warrants further investigation.

Respiratory Pressures and Thoracoabdominal Motion in Community-Dwelling Chronic Stroke Survivors

Teixeira-Salmela LF, Parreira VF, Britto RR, Brant TC, Inácio ÉP, Alcântara TO, Carvalho IF. Respiratory pressures and thoracoabdominal motion in community-dwelling chronic stroke survivors. Objective To investigate and characterize the muscular strength and components of breathing patterns in chronic stroke survivors compared with age-matched subjects. Design Descriptive case-control study. Setting Research laboratory. Participants Sixteen community-dwelling stroke survivors and 19 age-matched healthy subjects. Interventions Not applicable. Main Outcome Measures Maximal inspiratory (MIP) and expiratory pressure (MEP), tidal volume, respiratory rate, percentage of inspiratory time related to total respiratory cycle, mean inspiratory flow, and rib cage and abdominal contributions to tidal volume. Results Stroke subjects presented significantly lower MIP ( P<.01) and MEP ( P=.01) and a tendency for predominance of rib cage contributions ( P=.05) during tidal breathing. There were no significant differences between the other respiratory variables. Conclusions Decreases in strength of respiratory muscles and lower abdomen contributions were shown during the respiratory cycle in community-dwelling stroke subjects. Based on these findings, it can be hypothesized that the association of specific respiratory training could optimize the gains associated with cardiovascular training in stroke survivors.