Fugl-Meyer Assessment Of Lower Extremity Research Articles

Effects of VR task-oriented training combined with rTMS on balance function and brain plasticity in stroke patients: a randomized controlled trial study protocol

BackgroundBalance dysfunction affects 70% of stroke patients. Emerging neurophysiological approaches, such as virtual reality therapy (VRT) and repetitive transcranial magnetic stimulation (rTMS), have been proven by clinical studies that the balance function of stroke patients can be improved when applied alone, but there are relatively few studies on the combined treatment of balance dysfunction after stroke. This study aimed to evaluate the impact of a 4-week intensive intervention combining VRT and rTMS on both balance function and brain plasticity among stroke patients.MethodsThis single-blind, randomized controlled trial was conducted at the Rehabilitation Medical Center of the Rehabilitation General Hospital of Ningxia Medical University. A cohort of 136 stroke patients, with durations of 2 to 24 weeks post-stroke, were enrolled in the study. Participants were randomly allocated in a 1:1:1:1 ratio to four groups: the VR group (n = 34), the rTMS group (n = 34), the combined treatment group receiving both VR and rTMS (n = 34), and the control group undergoing traditional balance training (n = 34). All patients underwent a standardized inpatient rehabilitation program over 4 weeks. The VR group received daily 30-min sessions of VR therapy for 20 days. The rTMS group underwent daily sessions of rTMS stimulation for 20 min, targeting the motor imagery region in the affected hemisphere. The combination group received VR therapy after completing their rTMS treatment. The control group received conventional balance training, with each session lasting 30 min. Additionally, all patients received an extra 60 min of standard rehabilitation therapy twice daily. Assessments were conducted at baseline, 2 weeks, and 4 weeks post-treatment, using the Berg Balance Scale (BBS) as the primary measure, and secondary measures including the Timed Up-and-Go Test (TUGT), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), and 6-m walking test (6MWT), as well as assessments for brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VGEF), tyrosine receptor kinase (TrκB), motor-evoked potential latency (PL), central motor conduction time (CMCT), and amplitude.DiscussionThe widespread application of VR technology and rTMS in clinical settings is well-established. However, the potential synergistic effects of combining these modalities on balance function and neuroplasticity in stroke patients remain uncertain. Our hypothesis suggests that the integration of VR with rTMS may result in more pronounced improvements in both balance function and neuroplasticity among stroke patients, surpassing the outcomes achievable with VR alone, rTMS alone, or traditional therapy. The possible mechanism is that VR-based training combined with rTMS plays a superimposed effect, promoting better repair of damaged neurons and ultimately improving balance function in stroke patients. The positive results anticipated from this trial could provide objective evidence advocating for the concurrent use of VR and rTMS in clinical interventions.Trial registrationThe study protocol underwent review and approval by the Medical Research Ethics Committee of the General Hospital of Ningxia Medical University on January 26, 2024 (No. KYLL-2024–0162). Subsequently, it was registered in the Chinese Clinical Trial Registry on March 11, 2024 (registration number: ChiCTR2400081775). Currently, the study is still ongoing.

Altered Resting-State Electroencephalogram Microstate Characteristics in Stroke Patients.

Stroke remains a leading cause of disability globally and movement impairment is the most common complication in stroke patients. Resting-state electroencephalography (EEG) microstate analysis is a non-invasive approach of whole-brain imaging based on the spatiotemporal pattern of the entire cerebral cortex. The present study aims to investigate microstate alterations in stroke patients. Resting-state EEG data collected from 24 stroke patients and 19 healthy controls matched by age and gender were subjected to microstate analysis. For four classic microstates labeled as class A, B, C and D, their temporal characteristics (duration, occurrence and coverage) and transition probabilities (TP) were extracted and compared between the two groups. Furthermore, we explored their correlations with clinical outcomes including the Fugl-Meyer assessment (FMA) and the action research arm test (ARAT) scores in stroke patients. Finally, we analyzed the relationship between the temporal characteristics and spectral power in frequency bands. False discovery rate (FDR) method was applied for correction of multiple comparisons. Microstate analysis revealed that the stroke group had lower occurrence of microstate A which was regarded as the sensorimotor network (SMN) compared with the control group (p = 0.003, adjusted p = 0.036, t = -2.959). The TP from microstate A to microstate D had a significant positive correlation with the Fugl-Meyer assessment of lower extremity (FMA-LE) scores (p = 0.049, r = 0.406), but this finding did not survive FDR adjustment (adjusted p = 0.432). Additionally, the occurrence and the coverage of microstate B were negatively correlated with the power of delta band in the stroke group, which did not pass adjustment (p = 0.033, adjusted p = 0.790, r = -0.436; p = 0.026, adjusted p = 0.790, r = -0.454, respectively). Our results confirm the abnormal temporal dynamics of brain activity in stroke patients. The study provides further electrophysiological evidence for understanding the mechanism of brain motor functional reorganization after stroke.

Effectiveness of repetitive transcranial magnetic stimulation combined with intelligent Gait-Adaptability Training in improving lower limb function and brain symmetry after subacute stroke: a preliminary study

ObjectivesPersistent lower limb dysfunction is a major challenge in post-stroke recovery. Repetitive transcranial magnetic stimulation is recognized for addressing post-stroke motor deficits. Our study explores the efficacy of combining rTMS with gait-adaptive training to enhance lower limb function and regulatory mechanisms in subacute stroke. Materials and methodsThis randomized controlled trial enrolled 27 patients with subacute hemiparesis, dividing them into experimental and control groups. Both groups underwent gait-adaptability training 5 times/week for 4 weeks, with the experimental group receiving daily low-frequency transcranial magnetic stimulation before training. Primary outcomes included the pairwise derived brain symmetry index, lower-extremity Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale. Assessments occurred before and after the four-week intervention. ResultsThe experimental and control groups showed significant improvements in the Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale after the 4-week intervention compared to baseline (all p<0.05). However, the experimental group demonstrated significantly greater improvements compared to the control group in the Fugl-Meyer Assessment (p=0.024) and the 10-meter walk test (p=0.033). Additionally, the experimental group exhibited a more pronounced decrease in the pairwise derived brain symmetry index (p=0.026) compared to the control group. Within the experimental group, the cortical subgroup's pairwise derived brain symmetry index was significantly lower than that of the control group (p=0.006). ConclusionsCombining low-frequency transcranial magnetic stimulation with Gait-Adaptive Training effectively enhances lower limb function and Regulatory mechanisms of the cerebral hemisphere in subacute stroke recovery, and it can provide rapid and effective rehabilitation effect compared with gait adaptation training alone.

Effectiveness of kneeling training in improving mobility and balance post-stroke

BackgroundFall prevention and balance control constitute critical components of rehabilitation for stroke survivors. Kneeling training, characterized by its low center of gravity focus, has been incorporated into rehabilitation regimens to enhance postural control across various pathological conditions. Despite its widespread use, empirical evidence substantiating the efficacy of kneeling training is limited, particularly in the context of mobility and balance improvement for patients who have had a stroke. This study aims to substantiate the safety and effectiveness of kneeling training in individuals recovering from stroke.MethodsA randomized controlled trial comparing kneeling training and conventional rehabilitation training was conducted, involving sixty-seven participants allocated to the Kneeling Training Group (KNT) and the Conventional Rehabilitation Group (CVR). The KNT group underwent 30-minute sessions of kneeling training, while the CVR group received conventional treadmill walking training, both administered six times per week over four weeks. Evaluation encompassed the Fugl-Meyer Assessment for Lower Extremity (FMA-LE), the Berg Balance Scale (BBS), and gait analysis was conducted at baseline, as well as at the 2 and 4-week intervals.ResultsOur study established the safety of a 4-week kneeling training program. Notably, the KNT group exhibited more pronounced improvements in BBS scores at weeks 2 and 4 compared to the CVR group. However, no significant disparities emerged in FMA-LE and gait analysis between the two groups. Our findings suggest that kneeling training may serve as a viable option for enhancing lower limb balance in survivors who have had a stroke.ConclusionsWe conclude that kneeling training, characterized by its safety, simplicity, and no restrictions on location or equipment, represents a valuable therapeutic approach for enhancing walking balance in individuals recovering from stroke.Trial registrationClinical trials ChiCTR1900028385, December 20, 2019.

Optimal acupuncture methods for lower limb motor dysfunction after stroke: a systematic review and network meta-analysis.

The lower limb motor dysfunction caused by stroke is one of the main sequelae affecting patients' ability to live normally in the later period. Acupuncture treatment of limb movement dysfunction after stroke has been recommended by authoritative guidelines for reducing limb spasticity, enhancing limb strength and so on. However, the efficacy of different acupuncture methods in treating lower limb motor dysfunction after stroke remains controversial. In this paper, network meta-analysis (NMA) was used to prioritize various acupuncture intervention combinations commonly used in clinical practice, try to screen the acupuncture intervention scheme with the highest clinical efficacy and safety, and explore its rationality in guiding clinical practice. We searched a total of 4,312 studies from 8 databases and 2 clinical trial registries, and selected 43 articles for systematic review. We used pairwise meta-analysis and network meta-analysis to evaluate the efficacy and ranking of various acupuncture interventions. At the same time, the risk of bias, publication bias, and sensitivity of included randomized controlled trials were analyzed. The main outcome indicator was Fugl-Meyer assessment of lower extremity (FMA-LE), and the secondary outcome indicators were Modified Barthel Index (MBI), Berg balance scale (BBS) and Modified Ashworth scale (MAS). A total of 4,134 patients in 43 studies were included. The intervention included 9 acupuncture-related treatments, of which 20.9% were classified as high-risk. Among the four outcome indicators in pairwise meta-analysis, the effect of body acupuncture combined with conventional rehabilitation has the highest comprehensive credibility in terms of efficacy and safety comparing with conventional rehabilitation [SMD = 1.14, 95%CI (0.81, 1.46)], [SMD = 1.35, 95%CI (0.97, 1.72)], [SMD = 1.22, 95%CI (0.39, 2.05)], [SMD = 1.21, 95%CI (0.74, 1.44)]. In addition, multiple intervention methods, for example, warm acupuncture plus rehabilitation treatment for MBI and electroacupuncture plus body acupuncture plus rehabilitation treatment for BBS, may increase certain additional effects on different outcome indicators. This study proves that body acupuncture combined with rehabilitation treatment is the most widely used intervention method with the highest evidence quality in the treatment of lower limb motor dysfunction after stroke. However, for some other acupuncture methods, large samples and high-quality clinical randomized controlled trials are still needed to be fully verified.

Clinical Effect Analysis of Wearable Sensor Technology-Based Gait Function Analysis in Post-Transcranial Magnetic Stimulation Stroke Patients.

(1) Background: This study evaluates the effectiveness of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in improving gait in post-stroke hemiplegic patients, using wearable sensor technology for objective gait analysis. (2) Methods: A total of 72 stroke patients were randomized into control, sham stimulation, and LF-rTMS groups, with all receiving standard medical treatment. The LF-rTMS group underwent stimulation on the unaffected hemisphere for 6 weeks. Key metrics including the Fugl-Meyer Assessment Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and gait parameters were measured before and after treatment. (3) Results: The LF-rTMS group showed significant improvements in the FMA-LE, BBS, MBI, and various gait parameters compared to the control and sham groups (p < 0.05). Specifically, the FMA-LE scores improved by an average of 5 points (from 15 ± 3 to 20 ± 2), the BBS scores increased by 8 points (from 35 ± 5 to 43 ± 4), the MBI scores rose by 10 points (from 50 ± 8 to 60 ± 7), and notable enhancements in gait parameters were observed: the gait cycle time was reduced from 2.05 ± 0.51 s to 1.02 ± 0.11 s, the stride length increased from 0.56 ± 0.04 m to 0.97 ± 0.08 m, and the walking speed improved from 35.95 ± 7.14 cm/s to 75.03 ± 11.36 cm/s (all p < 0.001). No adverse events were reported. The control and sham groups exhibited improvements but were not as significant. (4) Conclusions: LF-rTMS on the unaffected hemisphere significantly enhances lower-limb function, balance, and daily living activities in subacute stroke patients, with the gait parameters showing a notable improvement. Wearable sensor technology proves effective in providing detailed, objective gait analysis, offering valuable insights for clinical applications in stroke rehabilitation.

Comparison Between Mirror Therapy and Mental Imagery in Improving Ankle Motor Recovery in Acute Stroke Patients: Experimental Study

Introduction: Stroke is the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Initially, some 80% of all patients with stroke experience motor impairments of the contralateral limb, i.e hemiparesis. Mirror therapy is relatively new therapeutic intervention that focuses on moving the unimpaired limb. Likewise, another technique called Mental imagery is the cognitive rehearsal of a task in the absence of movement. Aim and Objectives: To compare mirror therapy and mental imagery in improving ankle motor recovery in acute stroke patients. Methodology: 30 stroke patients were selected in the study, and were randomly assigned into two groups. Group A i.e. Mirror Therapy group (n=15) or the Group B i.e. Mental Imagery group (n=15). Both the groups received 30 minutes of their respective therapy that is mirror therapy and mental imagery and in addition to 30 minutes of conventional therapy which included neuro developmental facilitation technique, stretching, gait training that is a total of 1 hour per day for 5 days a week for 4 weeks. Modified Ashworth Scale, 10 Meter Walk test (10MWT), Fugl-Meyer assessment Lower extremity (FMA-LE) scale were administered pre and post intervention to assess the ankle motor function. Results: Only Fugl Meyer Assessment scores on comparison between Group A (Mirror Therapy) and Group B (Mental Imagery) revealed that statistically significant improvement was found in Group B (Mental Imagery) (t-value: 2.140; p-value: .041*). Conclusion: The present study concluded that Mental Imagery proved to be more effective than Mirror Therapy in improving ankle motor recovery in acute stroke patients.

A decision tree algorithm to identify predictors of post-stroke complex regional pain syndrome

This prospective cohort study aimed to identify the risk factors for post-stroke complex regional pain syndrome (CRPS) using a decision tree algorithm while comprehensively assessing upper limb and lower limb disuse and physical inactivity. Upper limb disuse (Fugl-Meyer assessment of upper extremity [FMA-UE], Action Research Arm Test, Motor Activity Log), lower limb disuse (Fugl-Meyer Assessment of lower extremity [FMA-LE]), balance performance (Berg balance scale), and physical inactivity time (International Physical Activity Questionnaire-Short Form [IPAQ-SF]) of 195 stroke patients who visited the Kishiwada Rehabilitation Hospital were assessed at admission. The incidence of post-stroke CRPS was 15.4% in all stroke patients 3 months after admission. The IPAQ, FMA-UE, and FMA-LE were extracted as risk factors for post-stroke CRPS. According to the decision tree algorithm, the incidence of post-stroke CRPS was 1.5% in patients with a short physical inactivity time (IPAQ-SF < 635), while it increased to 84.6% in patients with a long inactivity time (IPAQ-SF ≥ 635) and severe disuse of upper and lower limbs (FMA-UE score < 19.5; FMA-LE score < 16.5). The incidence of post-stroke CRPS may increase with lower-limb disuse and physical inactivity, in addition to upper-limb disuse. Increasing physical activity and addressing lower- and upper-limb motor paralysis may reduce post-stroke CRPS.

Influence of motor capacity of the lower extremity and mobility performance on foot plantar pressures in community-dwelling older women

ObjectivesTo investigate the associations of motor capacity of the lower extremity and mobility performance in daily physical activities with peak foot plantar pressures during walking among older women. MethodsUsing the data collected among 58 community-dwelling older women (68.66 ± 3.85 years), Pearson correlation and multiple linear regression analyses were performed to analyze the associations of motor capacity of the lower extremity (the 30-s chair stand test, the timed one-leg stance with eyes closed, and the Fugl-Meyer assessment of lower extremity), mobility performance in daily physical activities (the average minutes of moderate to vigorous physical activity every day and the metabolic equivalents), and foot plantar pressures (peak force and peak pressure) with the age and body fat percentage as covariates. Results(1) The motor capacity of the lower extremity has higher explanatory power for peak foot plantar pressures compared with the mobility performance in daily physical activities. (2) Higher body fat percentage was positively associated with peak force and pressure, while a lower score on the Fugl-Meyer assessment of lower extremity was negatively associated with both of them. (3) The metabolic equivalents were positively associated with the peak force, while the 30-s chair stand test was negatively associated with it. ConclusionsMobility performance in daily physical activities can be significant predictors for peak foot plantar pressures among older women. The significant predictor variables include the Fugl-Meyer assessment of lower extremity, the 30-s chair stand test, and metabolic equivalents.

Toe Grip Strength Is Associated with Improving Gait Function in Patients with Subacute Stroke.

Toe grip strength has recently been suggested to play an essential role in maintaining balance and postural stability for ambulatory function in older populations. This study aimed to investigate its association with improving gait function three months after onset in patients with subacute stroke. This longitudinal cohort study included 98 first-ever stroke patients (67 ± 9 years, 56% female) within one month from the onset who could not ambulate independently. Functional outcome indicators, including toe grip strength, hand grip strength, knee extensor strength, Fugl-Meyer Assessment of Lower Extremity (FMA_LE), and the Postural Assessment Scale for Stroke (PASS), were assessed before and three months after the intervention. We analyzed the correlation between participants' gait function using a 10-meter walk test time and various functional indicators. Then, multiple linear regression analysis was used to investigate whether toe grip strength was related to the improvement of gait function. Correlation analysis revealed a significant positive correlation between the 10MWT time and toe grip strength ratio (affected/unaffected side), with a moderate effect size (r = -0.61, p <0.001). Multiple regression analysis with covariates showed a significant relationship between 10MWT time and toe grip strength ratio (β = -0.113, p < 0.001), FMA_LE (β = -1.315, p = 0.004), PASS (β = -3.275, p <0.001), and age (β = -0.159, p = 0.004). In conclusion, toe grip strength was an essential factor associated with ambulatory function improvement in subacute stroke patients three months after onset. Additional toe grip muscle strengthening rehabilitation treatment can be expected to help improve the ambulatory function of subacute stroke patients in the future.

Gait Variability and its Relationship to Functional Mobility in Hemiparetic Stroke

Background: Stroke remains a leading cause of long-term disability worldwide, with hemiplegia being one of the most common outcomes, significantly impairing gait and functional mobility. The integration of sensory stimulation techniques into rehabilitation practices offers a promising avenue for enhancing recovery outcomes in hemiplegic stroke survivors. Objective: This study aimed to investigate the effectiveness of auditory and visual sensory stimulation on improving gait parameters and functional mobility in hemiplegic stroke patients. Methods: Conducted at Mayo Hospital, Lahore, this analytical cross-sectional study involved 24 stroke survivors with hemiplegia, randomly assigned to two intervention groups. Inclusion criteria included a Modified Ashworth Scale score of 1 to 1+ and a Mini-Mental State Examination score of ≥25. One group received auditory feedback gait training (AFGT) with smart insoles, while the other engaged in sit-to-stand training with visual feedback using a Wii Balance Board, alongside conventional rehabilitation therapies. The interventions lasted four weeks, with assessments conducted pre and post-intervention. Outcome measures included the Dynamic Gait Index (DGI), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), and various gait parameters. Statistical analysis was performed using SPSS version 25. Results: Post-intervention, the study observed significant improvements in DGI (mean increase: 3.5 points, p&lt;0.01), FMA-LE scores (mean increase: 10 points, p&lt;0.01), and enhanced gait parameters including step length and stride length (p&lt;0.05). The group receiving AFGT with smart insoles showed notable improvements in spatiotemporal gait parameters and balance compared to the control group, indicating the efficacy of sensory feedback in rehabilitation. Conclusion: The study demonstrates that incorporating auditory and visual feedback into rehabilitation regimens can significantly improve gait dynamics and functional mobility in hemiplegic stroke patients. These findings suggest the potential for sensory stimulation techniques to enhance the effectiveness of stroke rehabilitation, advocating for their integration into standard care practices.

Effect of Yoga on Gait, Balance, Trunk Control and Lower Limb Functions after Stroke: An Experimental Study

Introduction: Stroke is a leading cause of long-term disability, with lower limb dysfunction being the most common symptom. Impairments in balance, trunk control, and gait significantly impact mobility and quality of life. While conventional rehabilitation methods target these deficits, therapies like yoga may provide added benefits. This study aims to evaluate the effect of integrating yoga with conventional therapy on gait, balance, trunk control, and lower limb function in stroke patients. Methods: 32 subjects were randomly assigned to two groups. Group 1 received conventional therapy, while Group 2 underwent conventional therapy with yoga, 4-5 days per week for 4 weeks. Outcome measures included Brunnstrom Recovery Stage of Lower Extremity (BRS-LE), Fugl-Meyer Assessment Lower Extremity (FMA-LE), Barthel Index (BI), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Trunk Impairment Scale (TIS). Intra-group comparisons were analyzed using the Wilcoxon Signed Ranks Test, and inter-group differences were assessed using Mann-Whitney U test. Results: Both groups showed significant improvements in gait, balance, trunk control, and lower limb function. However, the experimental group demonstrated significantly greater improvements in BRS-LE, FMA-LE, BBS, and DGI scores compared to control group. Conclusion: Adding yoga to conventional therapy significantly enhances recovery of gait, balance, trunk control, and lower limb function in stroke patients.

Maximizing stroke recovery with advanced technologies: A comprehensive assessment of robot-assisted, EMG-Controlled robotics, virtual reality, and mirror therapy interventions

Inconvenience caused by stroke brings physical disability found in many people which restricts their daily life activities. Globally, it was predicted that the prevalence of stroke will rise to 21.9 % by 2030. To improve the sensory and motor recovery of the stroke survivors, they required high attention for their controllability and adaptability. About 80 % of stroke victims have upper-limb motor deficits which affects their daily living activities. Due to technological advancement in rehabilitation engineering with new interventions, traditional physical therapy for stroke patients now translates into new rehabilitation strategies which help in fast recovery of motor tasks with intention motions. Electromyography (EMG) based stroke rehabilitation now being developed for enhancement and assessment of motion control in clinical settings. The integration of EMG-based intervention provides the feasibility to use the concept of myoelectric control with therapeutic settings. In this paper, the use of EMG-based robot aided therapy has been discussed and highlights the contribution of interventions for stroke rehabilitation. Furthermore, discussion also emphasis on virtual reality and mirror therapy and their latest interventions and approaches carried out by different investigators for the evaluations and assessment of stroke rehabilitation in lieu of considerations for improved functional motor task. The most widely used functional outcome measures for conducting clinical assessment of stroke patients in randomized control trials (RCTs) are Fugl-meyer assessment-upper extremity (FMA-UE), a score range from 0 to 66points, Fugl-meyer assessment for lower extremity (FMA-LE) has a score from 0 to 34 points, the Action Research Arm Test (ARAT), a scale from 0 to 57 points, the Functional independence measure (FIM) has a scale of 18–126 points, Modified Ashworth Scale (MAS), a scale from 0 to 5 points and Box and block test (BBT). Furthermore, in most of the RCTs the statistical significance was set at p < 0.05 (95 % confidence interval). Moreover, future directions suggested that for real time autonomous detection of motion intentions, the EMG-based machine learning must be involved with robots, virtual reality and mirror therapy-based interventions to achieve 95 % accuracy that could leads to the development of intelligent rehabilitation interventions for stroke survivors.

Effects of soft robotic exoskeleton for gait training on clinical and biomechanical gait outcomes in patients with sub-acute stroke: a randomized controlled pilot study.

Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke.

End-effector lower limb robot-assisted gait training effects in subacute stroke patients: A randomized controlled pilot trial.

This pilot study investigated end-effector lower limb rehabilitation robot training effects in subacute stroke patients. Forty-nine stroke patients were randomly assigned to 2 treatment groups: a 30-minute end-effector lower limb rehabilitation robot training plus 1.5-hour conventional physiotherapy (robot group; n = 26), or a 2-hour conventional physiotherapy (control group; n = 23). All patients received 5 treatments weekly for 4 weeks. The functional ambulatory category was the primary outcome and the motricity index, Fugl Meyer assessment-lower extremity, rivermead mobility index, 10 meter walk test, Berg balance scale, and modified Barthel index were secondary outcomes. All outcome measures significantly improved in both groups after training (P > .05). The robot group improved more in FAC than the control group (P = .005). Compared with conventional physiotherapy alone, end-effector lower limb robot-assisted gait training with conventional physiotherapy improved subacute stroke patients walking ability.

Diaphragmatic breathing combined with abdominal drawing-in maneuver for walking function in post-stroke patients: a randomized controlled study protocol

BackgroundPatients with stroke frequently experience walking dysfunction. Core training can help improve balance and walking function in patients with stroke. However, core training movements in clinical practice are numerous and differently targeted. Therefore, this study will investigate the improvement of walking function in patients with combined diaphragmatic breathing maneuver (DBM) and draw-in breathing technique (ADIM) training.MethodsThis single-blind, randomized controlled preliminary will analyze the viability of DBM combined ADIM training versus routine rehabilitation therapy in patients with stroke with early to mid-stroke. Patients will be randomly assigned to either the DBM and ADIM training or the routine rehabilitation training. We will recruit 42 stroke inpatients from the Second Rehabilitation Hospital of Shanghai who meet the trial criteria and measure the balance and walking functions and improvement of that after 4 weeks of intervention. The primary outcome is the 10 m maximum walking test (10MWT). The secondary outcomes indices include the limits of stability test (LOS), Berg balance scale test (BBS), Functional Ambulation Categories test (FAC), Timed Up and Go test (TUG), trunk impairment scale test (TIS), ultrasound indicators of the diaphragm and transversus abdominis (UI), rhythmic weight shift test (RWS), walk across test (WA), Fugl-Meyer assessment of lower extremity (FMA-LE), and Barthel index of ADL test.DiscussionThe primary objective of this project was to investigate the effects of DBM combined with ADIM on balance capacity and walking function for patients with early to mid-stroke. The outcomes of this study will hold significant implications for future clinical applications in rehabilitation.Trial registrationChinese Clinical Trial Registry (ChiCTR), ID: ChiCTR2100054897. Registered on 28 December 2021.

Short-term and long-term predictors of balance function in stroke patients: a 6-month follow-up study.

We aimed to determine early predictors of balance function (Berg Balance Scale, BBS) at 3 and 6 months after stroke using clinical, neurophysiological, and neuroimaging variables. Seventy-nine patients with hemiparesis after a stroke were included. Demographics, stroke characteristics, and clinical variables [Mini-Mental State Examination, BBS, strength in the hemiparetic hip, knee, and ankle muscles, and Fugl-Meyer Assessment Lower Extremity (FMA-LE)] were evaluated 2 weeks post-stroke, on average. Somatosensory-evoked potentials (SEP) from both tibial nerves and diffusion tensor imaging data were collected respectively within 3 weeks and 4 weeks post-onset to calculate the SEP amplitude ratio and the laterality index of fractional anisotropy of the corticospinal tract. In multiple linear regression analysis, younger age, higher FMA-LE score, and stronger hemiparetic hip extensors were independent predictors of higher BBS at 3 months post-stroke (adjusted R2 = 0.563, P < 0.001). At 6 months post-stroke, significant predictors of higher BBS were younger age, higher FMA-LE, stronger hemiparetic hip extensors, and larger SEP amplitude ratio (adjusted R2 = 0.552, P < 0.001), although the incremental contribution of the latter was rather small ( R2 = 0.019). We conclude that age and the initial motor impairment of the affected lower limb can inform the state of balance function at 3 and 6 months after stroke.

Assessing the Turning Ability during Walking in People with Stroke Using L Test.

The L Test of Functional Mobility (L Test) was developed to assess the advanced mobility, which includes both turning and walking ability. This study aimed to evaluate (1) the intra-rater reliability of the L Test in four turning conditions, (2) the correlation with other stroke-specific impairment for community-dwelling older adults with stroke, and (3) the optimal cut-off completion time of the L Test to distinguish the difference of performance between healthy older adults and people with stroke. This is a cross-sectional design. Thirty older adults with stroke and healthy older adults were included. The subjects were assessed by L Test along with other stroke-specific outcomes. The L Test showed excellent intra-rater reliability (ICC = 0.945-0.978) for the four turning conditions. There were significant correlations between L Test completion times and Fugl-Meyer Assessment-Lower Extremity (FMA-LE) scores, Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores, Berg Balance Scale (BBS) score, and Timed Up and Go (TUG) Test scores. The cut-off of the L Test was established as 23.41-24.13 s. The L Test is an easy-to-administer clinical test for assessing the turning ability of people with stroke.

The effects of exercise intervention on cognition and motor function in stroke survivors: a systematic review and meta-analysis.

Cognitive impairment was a common sequela among stroke survivors, and exercise intervention was a promising non-pharmacological treatment modality for it. To explore the effects of exercise intervention programs on cognitive and motor function in patients with cognitive impairment after stroke. Systematic review and meta-analysis. Seven online databases (PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycInfo, and SPORTDiscus) were searched from their inception to 10 February 2022. Randomised controlled trials (RCTs) comparing the effects of exercise with non-exercise rehabilitation, using the Montreal Cognitive Assessment, Addenbrooke's Cognitive Examination, Mini-Mental State Examination, Trial Making Test, Upper and Lower Extremity Fugl-Meyer Assessment, Berg Balance Scale, and Barthel Index, were selected. Calculations for each assessment were performed for the overall effect and the therapy of interest, taking into account the effect of stroke severity or stimulus parameters. Twelve RCTs involving 975 participants and investigating nine different types of exercise interventions were included. The results were not affected by participant characteristics or reactive balance outcomes. Our results emphasise the importance of lightweight and operable aerobic exercises. Exercise itself had a high potential to improve cognitive impairment and motor function after stroke. Exercise had significant positive effects on alleviating cognitive and motor impairments after stroke.

Loaded and unloaded timed stair tests as tools for assessing advanced functional mobility in people with stroke.

The Timed Stair Test (TST) was originally designed to measure advanced functional mobility in patients who have undergone a total hip replacement. Its psychometric properties have not been examined systematically in people with stroke. The aims of this study were to: 1) determine the intra-rater reliability of TST under loaded and unloaded condition; 2) identify the minimal detectable changes (MDCs) in TST completion times; 3) investigate the concurrent validity between TST completion times and stroke-specific outcome measures; and 4) determine the cut-off TST completion time to differentiate the performance between people with stroke and healthy older adults. Cross-sectional study. A university-based rehabilitation center. Ninety-four people with stroke and 34 healthy older adults. TSTs were conducted under loaded and unloaded conditions. Two trials of the TST for each of the two conditions were performed on the same day. The Fugl-Meyer Assessment of Lower Extremity (FMA-LE), lower-limb muscle strength test assessed by a hand held dynamometer, Berg Balance Scale (BBS), Limit of Stability (LOS) Test, Timed Up and Go (TUG) Test, and the Cantonese version of the Community Integration Measure (CIM) were also used to assess the subjects. Excellent intra-rater reliability was demonstrated for TST completion times under loaded (intraclass correlation coefficient [ICC<inf>2,1</inf>]=0.991) and unloaded (ICC<inf>2,1</inf>=0.985) conditions. The MDCs in TST completion times were 6.55 seconds and 7.25 seconds under loaded and unloaded conditions, respectively. FMA-LE scores, mean strength of the affected-side dorsiflexors and plantar flexors, BBS scores, and LOS movement velocity and maximum excursion scores demonstrated fair to excellent negative correlations with TST completion times under both loaded (r=-0.314 to -0.786) and unloaded (r=-0.296 to -0.794) conditions. TUG results demonstrated good to excellent positive correlations with TST completion times under both loaded (r=0.875, P<0.001) and unloaded (r=0.872, P<0.001) conditions. The TST completion times of 26.3 seconds and 23.4 seconds under loaded and unloaded conditions, respectively, differentiated between people with stroke and healthy older adults. The TST is a reliable clinical tool for evaluating advanced functional mobility in people with stroke. TST is a fast and simple test that does not require sophisticated equipment, making it suitable for busy hospital and rehabilitation settings.