Exercise In Stroke Patients Research Articles

Pendampingan Latihan Range Of Motion (ROM) Pada Penderita Stroke

RANGE OF MOTION (ROM) EXERCISE ASSISTANCE IN STROKE PATIENTS. Stroke is the second leading cause of death and the third leading cause of disability in the world after heart disease and cancer in both developed and developing countries. Stroke occurs suddenly and causes symptoms, including paralysis of the face or limbs, speech is not fluent, speech is not clear (pelo), changes in consciousness, visual disturbances, and others. Stroke sufferers who experience disorders of the extremities require improvement of extremity motor skills through rehabilitation programs, one of which is range of motion (ROM) exercises. This community service activity is carried out through mentoring range of motion (ROM) exercises for stroke patients. ROM exercises are given using a cylindrical grip or a cylindrical tool made of wood. This tool is used by stroke patients for grasping exercises. When giving ROM exercises, stroke patients are accompanied by their families because this ROM exercise is not only done once but is carried out for 1 week with a frequency of 2 times a day (morning and evening) so it is hoped that there will be support from the family in helping stroke sufferers do this exercise. The results of community service activities showed that stroke patients experienced changes or increased muscle strength scales. Finger muscle strength can be increased by using cylindrical grip range of motion exercises. Stroke sufferers need to learn and apply ROM exercises in an effort to increase the scale of muscle strength.

Effects of Aerobic Exercise Variables on Production of Creatine Phosphokinase in Stroke Patients

Background: Physical therapy applied to stroke patients is recognized as a treatment that promotes function recovery, and it is a widely known fact that constant exercise should be performed. However, there are insufficient studies on exercise intensity and exercise time that can minimize side effects and maximize function recovery for exercise therapy. Objectives: To determine the effect of exercise variables on CPK generation during aerobic exercise in stroke patients and to discover how to use appropriate exercise intensity and time when conducting an exercise for function recovery in stroke patients. Design: Quasi-experimental research. Methods: This study classified subjects into three groups (low-intensity exercise group: LIE, moderate-intensity exercise group: MIE and high-intensity exercise group: HIE) according to exercise intensity, and was further classified into two groups (10-minute exercise group: 10MG and 20-minute exercise group: 20MG) according to exercise time variables within each exercise intensity group. After, the change in CPK according to exercise intensity and time was confirmed through hematological analysis. Results: In LIE and MIE, the CPK blood concentrations before and after exercise were increased in 10MG and 20MG, which was not statistically significant (P>.05). In HIE, the CPK blood concentrations before and after exercise were increased in 10MG, and it was statistically significant (P<.05). In HIE, the CPK blood concentrations before and after exercise were increased in 20MG, and it was statistically significant (P<.01). In 10MG and 20MG, the CPK blood concentrations before and after exercises were increased in all intensity group, and there was a statistically significant difference only in HIE. Conclusion: From the results of this study, considering CPK, it will be helpful to recover and improve function if the exercise intensity setting is applied in the type of moderate intensity exercise during physical therapy interventions in stroke patients.

Chronic hyperglycemia before acute ischemic stroke impairs the bilateral cerebrovascular response to exercise during the subacute recovery period.

Background and PurposeChronic hyperglycemia contributes to cerebrovascular dysfunction by damaging blood vessels. Poor glucose control has been tied to impairments in cerebral blood flow, which may be particularly detrimental for people recovering from major cerebrovascular events such as acute ischemic stroke. In this secondary analysis, we explore for the first time the connection between chronic hyperglycemia before acute stroke and the cerebrovascular response (CVR) to exercise 3 and 6 month into the subacute recovery period.MethodsWe recorded middle cerebral artery velocity (MCAv) using transcranial Doppler ultrasound bilaterally at rest and during moderate‐intensity exercise in stroke patients at 3 (n = 19) and 6 (n = 12) months post‐stroke. We calculated CVR as the difference between MCAv during steady‐state exercise and resting MCAv. We obtained hemoglobin A1c levels (HbA1c; a measure of blood glucose over the prior 3 months) from the electronic medical record (EMR) and divided participants by HbA1c greater or less than 7%.ResultsParticipants with high HbA1c (>7%) at the time of acute stroke had significantly lower CVR to exercise for both the stroke‐affected (p = .009) and non‐affected (p = .007) hemispheres at 3 months post‐stroke. These differences remained significant at 6 months post‐stroke (stroke‐affected, p = .008; non‐affected, p = .016).ConclusionsPatients with chronic hyperglycemia before acute ischemic stroke demonstrated impaired cerebrovascular function during exercise months into the subacute recovery period. These findings highlight the importance of maintaining tight glucose control to reduce morbidity and improve recovery post‐stroke and could have implications for understanding cerebrovascular pathophysiology.

Comparison of ground reaction force during gait between the nonparetic side in hemiparetic patients and the dominant side in healthy subjects.

Considering the occurrence of gait impairment following stroke, walk-ing recovery is an important goal of rehabilitation. Ground reaction force (GRF) is used for gait assessment of rehabilitation progress during exercise in stroke patients. The aim of this study was to compare the GRF during gait of the nonparetic side in hemiparetic patients and the dominant side in healthy subjects. Twenty hemiparetic patients and 20 healthy subjects were enrolled in the study. Force plate was used to evaluate GRF during gait. Additionally, with the patients and subjects in supine position, we measured their range of motion (ROM) in ankle dor-siflexion using a digital goniometer. The force values of stance phase on the nonparetic side of hemiparetic patients were significantly less than on the dominant side of healthy subjects (P<0.05). The impulse values of stance phase on the paretic side and the nonparetic side of hemiparetic patients were significantly greater than on the dominant side of healthy subjects (P<0.05). The ankle ROM result was signifi-cantly correlated with the GRF values (P<0.05). It is important to assess and understand the nonparetic side as well as paretic side. These re-sults suggest that the analysis of GRF for exercise rehabilitation will be a valuable clinical evaluation in hemiparetic patients after a stroke.

Effects of resistive jaw opening exercise in stroke patients with dysphagia: A double- blind, randomized controlled study.

The resistive jaw opening exercise (RJOE) was suggested as a potential remedial treatment for patients with dysphagia. However, clinical evidence is insufficient. To investigate the effect of RJOE on hyoid bone movement, aspiration, and oral intake level in stroke patients with dysphagia. Forty stroke patients with dysphagia were randomly allocated into either the experimental group (n= 20) or placebo group (n= 20). The experimental group performed RJOE using a portable device, while the placebo group performed RJOE using a sham device with fewer loads. Intervention was conducted 5 times a week for 4weeks. Hyoid bone movement was analyzed by two-dimensional analysis of anterior and superior motion based on a videofluoroscopic swallowing study. Aspiration was assessed using a penetration-aspiration scale (PAS), and oral intake level was assessed using the functional oral intake scale (FOIS). Both groups showed statistically significant differences in hyoid movement, PAS, and FOIS scale (p< 0.05). However, after the intervention, there was no significant difference between the two groups except for the liquid type of PAS. Effect sizes (Cohen's d) were 0.9 and 0.7, 0.6 and 0.6, and 1.1 for the anterior and superior movement of the hyoid bone, semisolid and liquid type of PAS, and FOIS scale respectively. This study suggests that RJOE helps in hyoid movement, aspiration reduction, and oral intake in patients with dysphagia after stroke.

Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity.

Physical exercise can minimize dysfunction and optimize functional motor recovery after stroke by modulating cortical plasticity. However, the limitation of physical exercise is that large amounts of time and effort are necessary to significantly improve motor function, and even then, substantial exercise may not be sufficient to normalize the observed improvements. Thus, interventions that could be used to strengthen physical exercise-induced neuroplasticity may be valuable in treating hemiplegia after stroke. Repetitive transcranial magnetic stimulation seems to be a viable strategy for enhancing such plasticity. As a non-invasive cortical stimulation technique, repetitive transcranial magnetic stimulation is able to induce long-term plastic changes in the motor system. Recently, repetitive transcranial magnetic stimulation was found to optimize the plastic changes caused by motor training, thereby enhancing the long-term effects of physical exercise in stroke patients. Therefore, it is believed that the combination of repetitive transcranial magnetic stimulation and physical exercise may represent a superior method for restoring motor function after stroke.

Effects of Mirror Therapy and Cognitive Therapeutic Exercise in Stroke Patients

Effects of Mirror Therapy and Cognitive Therapeutic Exercise in Stroke Patients

Study on motion performance of robot-aided passive rehabilitation exercises using novel dynamic motion planning strategy

The motion rehabilitation training robot is developed to help patients with motion dysfunction recover their motor function by providing a large amount of repetitive robot-aided exercise. To achieve stable and smooth robot-aided exercises for stroke patients, a motion control method with a novel dynamic motion planning strategy is proposed. The physical state of the training limb is assessed real time during the rehabilitation exercises. The dynamic motion planning strategy is developed by employing a suitable interpolation method dynamically corresponding to the physical state of the training limb to plan a trajectory tracking system that completely utilizes different interpolation characteristics to manage the movement in accordance with the time-varying physical state of the training limb. Concurrently, a position-based impedance control is adopted to achieve compliant movement. Functional (quantitative and qualitative) and clinical experiments are conducted on a four-degree-of-freedom whole-arm manipulator upper limb rehabilitation robot to verify the effectiveness of the control method designed with the dynamic motion planning strategy. The results indicate that the proposed control strategy can exhibit better performances in terms of the stability and smoothness.

Effects of Combined Cognitive Training With Aerobic Exercise in Stroke Patients With MCI

Effects of Combined Cognitive Training With Aerobic Exercise in Stroke Patients With MCI

A pilot study on the immediate and long-term effects of hybrid therapy of computer-based cognitive training and aerobic exercise in stroke patients with cognitive decline

While the salient physical disability after stroke has long been emphasized, post-stroke cognitive decline hindering motor and functional recovery is often ignored. This study evaluated the immediate and long-term effects of hybrid therapies of computer-based cognitive training and aerobic exercise in stroke patients with cognitive decline. Stroke survivors with cognitive decline were separated into sequential (SEQ) and control groups (CON). Participants in the SEQ group ( n = 15) received 30-minute aerobic exercise followed by 30-minute computerized cognitive training; participants in the CON group ( n = 12) received 30-minute non-aerobic exercise (e.g., stretching and muscle strengthening) and 30-minute unstructured cognitive training (e.g., reading newspapers and playing board games). All participants received trainings for three days per week for 12 weeks. The cognitive function outcomes included Montreal Cognitive Assessment (MoCA) and Verbal Paired Associates and Word Lists subtests from the Wechsler Memory Scale-III (WMS-III). Health-related quality of life was measured by EQ5D. Outcome measures were administered at baseline, immediately after training (3rd month), and at 6-month follow-up (9th month). Preliminary results showed that the SEQ group showed greater improvement in MoCA, WMS-Verbal Pair and Word Lists at post-training than the CON group, but not the EQ5D. These effects remained or had less decrements 6 months post-training compared to the CON group. Hybrid therapy of computer-based cognitive training and aerobic exercise training is favored to facilitate cognitive function in stroke survivors with cognitive decline. Our study demonstrates the potential benefit of this hybrid approach for long-term enhancement of cognition following stroke.

Abstract TP140: The Beneficial Effects of Sequential Combination of Cognitive Training and Aerobic Exercise in Stroke Patients With Cognitive Decline

Introduction: Post-stroke cognitive decline is a major problem that affects up to 70% of stroke survivors. Combination of aerobic exercise and cognitive training has been found to be effective for improving cognitive functions in individuals with dementia and community-dwelling elderly. However, the training effects of combined training on stroke survivors with cognitive decline require further investigation. Hypothesis: A sequential combination of aerobic exercise and cognitive training would be effective than control training on cognitive function, physical activity, and quality of life in stroke survivors with cognitive decline. Methods: Stroke survivors with cognitive decline were recruited and separated into sequential (SEQ) and control groups (CON). Participants in the SEQ group (N=15) first received 30-minute aerobic exercise followed by 30-minute computerized cognitive training; participants in the CON group (N=15) received non-aerobic exercise and unstructured cognitive training for 60 minutes. All participants received trainings for three days per week for 12 weeks. The cognitive function outcomes included Montreal Cognitive Assessment (MoCA) and double decision (i.e., visual spatial processing). Six-minute walk test (6MWT) and International Physical Activity Questionnaire (IPAQ) were used to evaluate physical activity. Quality of life was assessed by Stroke Impact Scale (SIS). We used paired sample t-test to examine the within group training effect and analysis of covariance to determine the between groups training effect. Results: From pre to post training, the SEQ group improved cognitive function (MoCA, p &lt;0.001; double decision, p =0.006), physical function (6MWT, p =0.038; IPAQ, p =0.052) but not quality of life (SIS, p =0.47). The CON group, however, had no significant changes across all variables (all p ’s&gt;0.05). Compared to the CON group, the SEQ group improved cognitive function (MoCA, p =0.03) and physical activity (6MWT, p =0.025), but no group difference was found in double decision, IPAQ and SIS. (all p ’s&gt;0.05). Conclusions: A sequential combination of aerobic exercise and cognitive training approach is favored to facilitate cognitive function and physical activity in stroke survivors with cognitive decline.

A low cost wearable wireless sensing system for paretic hand management after stroke

This paper describes the design of a low cost wearable hand exercise device that can assist repetitive wrist and finger exercise for stroke patients. The design of this device was guided by neurobiological principles of motor learning, such as sensory-motor integration, movement repetition, and cognitive interaction. This pilot study tested the efficacy of a wireless sensing system in the device to serve as a facilitator of repetitive hand exercise, which is an essential part of rehabilitation after stroke. The results from healthy young adults showed that the device with a wireless sensing system yielded quantitatively better motor function with the repetitive wrist and finger joint movements.This proof-of-concept study shows potential therapeutic evidence for stroke rehabilitation as well as the potential utility of sensing system for stroke rehabilitation.

Encouraging post-stroke patients to be active seems possible: results of an intervention study with knowledge brokers

Purpose: Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising nurses and therapists, on health professionals’ (HP) performance to encourage stroke inpatients to be physically active. Method: This multicenter intervention study used a pre–post test design. Two or three KBs were trained in each stroke unit of 12 hospitals and 10 rehabilitation centres in The Netherlands. Questionnaires were completed by patients and HPs before and after the KB-intervention. The primary outcome was encouragement given by HPs to their patients to be physically active, as reported by patients and HPs. Results: After the KB-intervention, many more patients (48%; N=217) reported at least some encouragement by HPs to be physically active than before (26%; N=243, p<0.000). HPs (N=288) on an average reported encouraging patients more often after the intervention, but this difference was significant only for occupational therapists and KBs. Conclusions: Based on patient’s reports of HP behaviour, the KB-intervention appears effective since more patients felt encouraged to be physically active after the intervention compared to before. Replication of this study in an experimental design is needed to allow causal inferences.Implications for rehabilitationWe advise rehabilitation teams to make use of knowledge brokers (KBs), since the KB-intervention was shown to increase the encouragement felt by stroke patients to be physically active.It seems worthwhile to involve physicians, nurses and patients’ families more frequently in efforts to encourage stroke patients to be physically active.

Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study.

[Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion.

Effect of Upper Extremity Robot-Assisted Exercise on Spasticity in Stroke Patients.

ObjectiveTo determine the efficacy of a stretching and strengthening exercise program using an upper extremity robot, as compared with a conventional occupational therapy program for upper extremity spasticity in stroke patients.MethodsSubjects were randomly divided into a robot-assisted therapy (RT) group and a conventional rehabilitation therapy (CT) group. RT group patients received RT and CT once daily for 30 minutes each, 5 days a week, for 2 weeks. RT was performed using an upper-extremity robot (Neuro-X; Apsun Inc., Seoul, Korea), and CT was administered by occupational therapists. CT group patients received CT alone twice daily for 30 minutes, 5 days a week, for 2 weeks. Modified Ashworth Scale (MAS) was used to measure the spasticity of upper extremity. Manual muscle tests (MMT), Manual Function Tests (MFT), Brunnstrom stage, and the Korean version of Modified Barthel Index (K-MBI) were used to measure the strength and function of upper extremity. All measurements were obtained before and after 2-week treatment.ResultsThe RT and CT groups included 22 subjects each. After treatment, both groups showed significantly lower MAS scores and significant improvement in the MMT, MFT, Brunnstrom stage, and K-MBI scores. Treatment effects showed no significant differences between the two groups.ConclusionRT showed similar treatment benefits on spasticity, as compared to CT. The study results suggested that RT could be a useful method for continuous, repeatable, and relatively accurate range of motion exercise in stroke patients with spasticity.

Efficacy of pulmonary rehabilitation using cervical range of motion exercise in stroke patients with tracheostomy tubes.

[Purpose] In this study, stroke patients who were intubated with tracheostomy tubes performed cervical range of motion exercises, and changes in their pulmonary and coughing functions were examined. [Subjects and Methods] Twelve stroke patients who were intubated with tracheostomy tubes participated in the study. The subjects were randomly assigned to either the control group (n=6), which did not perform cervical range of motion exercises, or the experimental group (n=6), which did perform exercises. [Results] With regards to forced vital capacity, forced expiratory volume at one second, and peak cough flow rate before and after the exercises, the control group did not show any significant differences while the experimental group showed statistically significant increases in all three parameters. [Conclusion] The results indicate that cervical range of motion exercises can effectively improve the pulmonary function and coughing ability of stroke patients intubated with tracheostomy tubes, and that cervical range of motion exercises can help in the removal of tracheostomy tubes.

Cardiovascular response during submaximal underwater treadmill exercise in stroke patients.

ObjectiveTo evaluate the cardiovascular response during head-out water immersion, underwater treadmill gait, and land treadmill gait in stroke patients.MethodsTen stroke patients were recruited for underwater and land treadmill gait sessions. Each session was 40 minutes long; 5 minutes for standing rest on land, 5 minutes for standing rest in water or on treadmill, 20 minutes for treadmill walking in water or on land, 5 minutes for standing rest in water or on treadmill, and 5 minutes for standing rest on land. Blood pressure (BP) and heart rate (HR) were measured during each session. In order to estimate the cardiovascular workload and myocardial oxygen demand, the rate pressure product (RPP) value was calculated by multiplying systolic BP (SBP) by HR.ResultsSBP, DBP, mean BP (mBP), and RPP decreased significantly after water immersion, but HR was unchanged. During underwater and land treadmill gait, SBP, mBP, DBP, RPP, and HR increased. However, the mean maximum increases in BP, HR and RPP of underwater treadmill walking were significantly lower than that of land treadmill walking.ConclusionStroke patients showed different cardiovascular responses during water immersion and underwater gait as opposed to standing and treadmill-walking on land. Water immersion and aquatic treadmill gait may reduce the workload of the cardiovascular system. This study suggested that underwater treadmill may be a safe and useful option for cardiovascular fitness and early ambulation in stroke rehabilitation.

Electromyographic analysis of upper limb muscles during standardized isotonic and isokinetic robotic exercise of spastic elbow in patients with stroke

Although it has been reported that strengthening exercise in stroke patients is beneficial for their motor recovery, there is little evidence about which exercise method is the better option. The purpose of this study was to compare isotonic and isokinetic exercise by surface electromyography (EMG) analysis using standardized methods.Nine stroke patients performed three sets of isotonic elbow extensions at 30% of their maximal voluntary isometric torque followed by three sets of maximal isokinetic elbow extensions with standardization of mean angular velocity and the total amount of work for each matched set in two strengthening modes. All exercises were done by using 1-DoF planner robot to regulate exact resistive torque and speed. Surface electromyographic activity of eight muscles in the hemiplegic shoulder and elbow was recorded. Normalized root mean square (RMS) values and co-contraction index (CCI) were used for the analysis.The isokinetic mode was shown to activate the agonists of elbow extension more efficiently than the isotonic mode (normalized RMS for pooled triceps: 96.0±17.0 (2nd), 87.8±14.4 (3rd) in isokinetic, 80.9±11.0 (2nd), 81.6±12.4 (3rd) in isotonic contraction, F[1,8]=11.168; P=0.010) without increasing the co-contraction of muscle pairs, implicating spasticity or synergy.

Using Aerobic Exercise to Improve Health Outcomes and Quality of Life in Stroke: Evidence-Based Exercise Prescription Recommendations

Background: Stroke patients often suffer from poor cardiovascular health and deficits in physical, psychosocial and cognitive functioning. Aerobic exercise training may be a viable treatment approach to address these health issues. The objective of this systematic review was to determine the effects of aerobic exercise on various indicators of health, functioning and quality of life in stroke patients. It was hypothesized that the systematic review would reveal compelling support for the effectiveness of aerobic exercise in stroke patients, such that detailed evidence-based exercise prescription recommendations could be derived. Methods: Major electronic databases were searched systematically to identify randomized controlled studies that examined the effects of aerobic exercise in stroke patients (last search performed in January 2012). The methodological quality of each study was evaluated using the PEDro scale (9–10 = excellent; 6–8 = good; 4–5 = fair; <4 = poor). Based on the methodological quality and sample size used, the level of evidence was determined for each study (level 1: PEDro ≥6 and sample size >50; level 2: PEDro ≤5 or sample size ≤50). Meta-analysis was performed on a given outcome when appropriate. Results: Twenty-five trials fulfilled the selection criteria, of which 8 were level 1 studies. Treadmill and cycle ergometer were the two most popular modalities used to provide aerobic training. The most commonly adopted exercise session duration and frequency was 21–40 min and 3–5 days per week, respectively. The duration of the training programme varied, ranging from 3 weeks to 6 months. Over 60% of the trials used a high training intensity [60–80% heart rate reserve (HRR)]. Meta-analysis showed a significant effect on peak oxygen consumption (p < 0.001), peak workload (p < 0.001), maximal gait speed (p = 0.003) and walking endurance (p < 0.001) in favour of aerobic exercise. Meta-analysis revealed no significant effect on self-selected gait speed, Berg balance score and Functional Independence Measure score. The efficacy of aerobic exercise in improving other health outcomes in physical, psychosocial and cognitive domains as well as quality of life was inconclusive. The health risk associated with engaging in such exercise is small. Conclusions: There is strong evidence that aerobic exercise (40–50% HRR progressing to 60–80%) conducted 20–40 min and 3–5 days per week is beneficial for enhancing aerobic fitness, walking speed and walking endurance in people who have had mild to moderate stroke and are deemed to have low cardiovascular risk with exercise after proper screening assessments (grade A recommendation). The effects of aerobic exercise on other health outcomes require further study.

Exercise for Better ALS Management?

Exercise for Better ALS Management?