Hemiparetic Side Research Articles

Effects of Limbs' Spasticity on Spinopelvic Alignment in Post-Stroke Patients: A Cross-Sectional Study.

Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation-ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = -0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = -0.36, p = 0.04) and the ATR (β = -0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side.

The effects of trunk repositioning errors on trunk and extremity functions in stroke

ABSTRACT Aim The aim of this study was to analyze the TRE in three directions including forward flexion, lateral flexion to the hemiparetic side, and rotation to the hemiparetic side in patients with stroke and to compare the errors with age- and sex-matched healthy subjects. In addition, it was investigated which functional outcomes were explanatory for TRE in patients with stroke. Methods Forty-one patients with subacute/chronic stroke (age 59 ± 14.5 years) and 41 healthy subjects (age 57 ± 12.8 years) were included in the study. Demographic and clinical data were collected. TREs were measured using an inclinometer. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Timed Up and Go Test, and 10-m walk test (10MWT) were also used to assess trunk control, motor impairment, upper extremity function, and lower extremity function, respectively, in patients with stroke. Results TRE scores in three directions were higher in patients with stroke than in healthy subjects (p < 0.001). TREs in three directions were significantly strongly correlated with all functional outcomes (ρ > 0.60, r < 0.001). Multiple regression analysis determined 10MWT, WMFT-Performance, TIS, and FMA-Upper Extremity as explanatory factors for TRE. Conclusion The model presented in this study could help clinicians and researchers to predict the TRE in patients with stroke. Gait speed, upper extremity motor ability, upper extremity motor impairment, and trunk control should be considered for TRE after a stroke.

Effect of active and passive techniques used in thromboembolic prophylaxis on venous flow velocity in the post-procedure period.

Studies have shown that using mechanical thromboembolic prophylaxis methods speeds up venous flow and decreases stasis. These studies examine the post-intervention period of 1-10min. The length of the effect of procedures to raise venous flow velocity cannot be determined by clinical trials. To apply mathematical techniques to estimate how long mechanical thromboembolism prophylaxis procedures will increase venous flow rate. In the survey, we examined 25 persons (poststroke patients), with an average age of 57.2 ± 6.3 years. Regarding the proportion of genders, 13 (52%) participants were male and 12 (48%) female. The peak venous blood flow velocity was measured with a HADECO BIDOP ES-100V II type Doppler ultrasound device, using an 8MHz head, in the femoral vein, at the level of the hip joint. We estimated the change of the venous blood flow velocity from the available sampled data using the method of least squares. For the calculations, we used Microsoft Excel, version Mac Excel 2019. The decrease in peak venous flow velocity can be approximated by a logarithm function. Mathematical calculations show that after active thromboembolic prophylaxis interventions, resting venous flow velocity is restored at 26.8min on the intact limb and 85.1min on the hemiparetic side. Resting flow velocity is restored in 131.9min after passive mobilization of the hemiparetic side and in 137.7min after the consensual effect. An elementary mathematical function can be used to estimate the time to recovery of peak venous flow velocity to resting state from measurements taken 15min after the intervention. Active and passive mechanical thromboembolic prophylaxis after the intervention has a longer-term effect on venous flow velocity.

Efeito agudo da terapia por ondas de choque na pressão plantar e equilíbrio de indivíduos hemiparéticos

Abstract Introduction: Cerebral vascular accident (CVA) is the second leading cause of death and is one of the diseases that most generate disability Hemiparesis is the most common motor deficit, and one of its characteristics is asymmetry in weight bearing and in the plantar sup-port area, leading to balance deficits. extracorporeal shock-wave therapy (ESWT) has been shown to be effective in reducing post-stroke spasticity. Objective: To evaluate the effect of a ESWT session on the distribution of plantar pressure and on the static and dynamic balance of hemiparetic individuals after stroke. Methods: Twelve individuals with hemiparesis as a result of stroke in the chronic stage participated in the study. Data collection was divided into two days. On the first day, anamnesis and tests were performed: timed up and go (TUG), four square step test (FSST), and short physical performance battery (SPPB). After carrying out the tests, the distribution of plantar pressure was evaluated using baropodometry. Also on the first day, participants received ESWT in the muscle belly of the gastrocnemius muscle on the hemiparetic side. At the end of the ESWT session and after 7 days, the individuals were reassessed. Results: The results referring to the static and dynamic balance and baropodometry evaluations performed before, immediately after and one week after the application of ESWT did not show a significant difference between the three evaluations in any of the tests and in any of the moments performed. Conclusion: One ESWT session did not affect plantar pressure distribution and static and dynamic balance of hemiparetic individuals after stroke.

Does the ankle affect knee hyperextension during gait in hemiparetic stroke? A pilot study.

Knee hyperextension is common following stroke because of changes in joint range of motion (ROM), muscle tone and strength on the hemiparetic side. There is no clear consensus in the literature as to the cause of knee hyperextension during the stance phase of gait. Our study aimed to determine the feasibility of methods to investigate the association between ankle joint function and knee hyperextension in patients with hemiparetic stroke during the stance phase of gait. We used a cross-sectional observational study to assess bilateral ankle muscle strength using a handheld dynamometer, ROM using a digital inclinometer and muscle tone using the Modified Tardieu Scale. The knee angles of the hemiparetic leg during the stance phase of gait were assessed using the Kinovea movement analysis software. Data were analysed using the Statistical Package for the Social Sciences with significance level set at 0.05 and 95% confidence intervals. Twelve participants were included, and no alterations were necessary to the planned methodology. We found positive associations in six participants between the tibialis anterior muscle tone and the hemiparetic knee angles during heel strike, terminal stance and pre-swing phases (p < 0.05, p < 0.01 and p < 0.01, respectively). The results of the data analysis suggests that there may be a correlation between tibialis anterior muscle tone and knee hyperextension, a larger study will be imperative to confirm this association. The methods described in our pilot study are feasible for a larger study to be conducted with the recommendations considered.

Exploration of arm weight effects on hemiparetic stroke participants' gait performance

BackgroundThis study explores the potential benefits of an arm weight intervention for improving gait performance in stroke survivors. Consistent with an interlimb neural coupling mechanism, the investigators hypothesized that arm weight would improve gait performance. MethodsNine stroke and nine healthy participants (1 female; age: 58.0 ± 6.8 years) participated. Participants walked over-ground at their preferred speed in four conditions: no weight (C1), non-hemiparetic (healthy: dominant) side weights (C2), hemiparetic (non-dominant) side weights (C3), and bilateral weights (C4). Statistical analyses included repeated analysis of variance (ANOVA) and paired t-test planned comparisons to explore the effects of added weight on gait speed, step width, step length, cadence, and arm swing amplitude. Single-subject analyses used randomization tests to delineate further the weight's effect on gait speed. FindingsThe stroke group walked significantly faster with arm weight (p = 0.048), exhibiting large ANOVA (η2p = 0.28) and C1 vs. C4 planned comparison (p = 0.021; dD = 0.95) effect sizes. Four of nine stroke participants significantly increased gait speed in at least one condition, and seven of nine exhibited large effect size increases (d = 0.85–4.71). The stroke group's hemiparetic-side step length and cadence significantly (p = 0.008) increased in C4 compared to C1, exhibiting large effect size increases (rb = 0.96). Four of nine healthy participants significantly increased gait speed in at least one condition, with five of nine exhibiting large effect size increases (d = 0.80–6.63). InterpretationThis study's exploratory results demonstrate arm weight's potential for improving higher-functioning stroke survivors' gait performance. Arm weight addition merits further investigation as a possible rehabilitation intervention in the stroke population.

Does training to sustain the paretic upper limb on an unstable surface provoke contraction of muscles around the shoulder in patients with hemiplegia? A pilot randomized controlled trial

IntroductionActivities with unstable supports provoke greater muscle contractions than those with stable surfaces. Using unstable surfaces to provoke upper limb muscle contraction after hemiplegia has not been explored. Hence, this study tested the effect of efforts to maintain the hemiparetic hand on an unstable surface on proximal muscle contractions of upper limb in patients with acute stroke.MethodsFirst-time stroke patients in the acute phase were randomly allocated into 2 groups. The control group (&lt;i&gt;n&lt;/i&gt; = 18) received conventional physiotherapy, whilst the experimental group (&lt;i&gt;n&lt;/i&gt; = 19) was given activities to maintain their hemiparetic side hand on an unstable surface in 5 different positions, in addition to conventional physiotherapy. Surface electromyogram was recorded from deltoid and upper trapezius on the hemiparetic side before and after 10 sessions of training.ResultsOverall, 14 patients (aged 57.71 ± 10.70 years) in the control group and 14 (55.78 ± 7.52 years) in the experimental group completed the training. Non-parametric tests for between-group analysis showed that the average electromyography output in the deltoid and trapezius muscles was higher in the experimental group compared with the control group (&lt;i&gt;p&lt;/i&gt; &lt; 0.05).ConclusionsTraining involving efforts to maintain the hemiparetic side hand on an unstable surface can be used to provoke activity in upper limb proximal muscles. This could be a simple training with minimal equipment and minimal manual assistance required, added to routine physiotherapy to facilitate proximal muscle contraction in patients with stroke during the acute phase.

Assistive Powered Hip Exoskeleton Improves Self-Selected Walking Speed in One Individual with Hemiparesis: A Case Study.

Most individuals suffering a stroke have permanent weakness on one side of the body (hemiparesis) that reduces their ability to ambulate. Autonomous powered exoskeletons have been proposed as a possible solution to this problem. Studies with healthy subjects show that assistive powered exoskeletons have the potential to improve gait, for example, by reducing the metabolic cost of walking. However, only a handful of studies have been conducted with individuals with hemiparesis. Thus, the ability of autonomous exoskeletons to improve gait in this population remains largely unknown. In this study, we assess self-selected walking speed with and without an autonomous powered hip exoskeleton in one individual with hemiparesis walking on level ground. Results show that the proposed exoskeleton improves self-selected walking speed by ~30%. The biomechanical analysis suggest that the increased walking speed is the result of the powered hip exoskeleton enabling the subject to take longer strides on the hemiparetic side. This case study provides important information to inform future exoskeleton development and clinical study design.

Post-Stroke Lateropulsion: Resolution and Function After Discharge From Inpatient Rehabilitation - A Cohort Study.

A person with post-stroke lateropulsion pushes their body toward their hemiparetic side and/or resists accepting weight onto their nonparetic side. Research findings regarding long-term persistence of lateropulsion and its association with function are lacking. This study reports associations between lateropulsion severity (Four Point Pusher Score - 4PPS) and functional outcome (Functional Independence Measure - FIM) at three months after discharge. This prospective cohort study included 41 consecutive admissions to a stroke rehabilitation unit. Lateropulsion severity and FIM were measured at admission, discharge and three-month follow-up. Lateropulsion status at discharge, stroke laterality, ongoing physiotherapy after discharge, and demographic variables (age and sex) were tested for association with FIM change over the follow-up period. Complete data were available for 38 participants. Among these, 17 (44.7%) showed lateropulsion (4PPS ≥ 1) on admission, 9 (23.7%) showed persistent lateropulsion on discharge, and 7 (18.4%) showed persistent lateropulsion at three month follow-up. Improved functional status (FIM score) was seen at follow-up in those discharged with lateropulsion who had right-sided lesions but not in those with left-sided lesions. Lateropulsion can continue to resolve after discharge from inpatient rehabilitation. Larger cohort studies are needed to further explore associations between persistent lateropulsion and long-term outcomes.

Factors related to daily step counts of stroke patients during hospitalization in a convalescent rehabilitation ward

ObjectivesClarifying the factors related to decreased physical activity in post-stroke patients is essential for effective disease management. This study aimed to examine the factors influencing the amount of daily steps taken by post-stroke patients in a convalescent rehabilitation ward during activities other than rehabilitation (non-rehabilitation steps). Materials and methodsEighty-nine post-stroke patients (60.8±14.4 years; 55 men) were enrolled. The inclusion criteria were walking independently within the ward and having a walking speed of ≥24 m/min. Data on patient clinical characteristics including age, sex, body mass index, stroke type, hemiparetic side, and time from stroke onset were collected. Stroke impairment and motor and cognitive functional disabilities were assessed using the Stroke Impairment Assessment Set and the Functional Independence Measure, respectively. The non-rehabilitation steps were calculated by subtracting the steps during the rehabilitation activities from the total steps using Fitbit Flex2. ResultsThe average number of non-rehabilitation steps was 4,523±2,339 steps/day. The hierarchical multiple regression analysis revealed that sex, motor disability, and the interaction term of stroke impairment with cognitive disability were significantly related to non-rehabilitation steps. Simple slope analysis demonstrated that the stroke impairment slope was steeper at lower levels than at higher levels of cognitive disability for non-rehabilitation steps. ConclusionsIn addition to independent effects of sex and motor disability, this study found that stroke impairment and cognitive disability were interactively related to non-rehabilitation steps in post-stroke patients in a convalescent rehabilitation ward. These findings may provide useful information for managing physical activity in post-stroke patients after hospital discharge.

Anodal tDCS of contralesional hemisphere modulates ipsilateral control of spinal motor networks targeting the paretic arm post-stroke

ObjectiveThe role of ipsilateral motor cortex efferent pathways in the transmission of voluntary command to spinal motor nuclei remains controversial in humans. In healthy subjects, their implication in cortical control is hidden by predominant role of crossed corticospinal tract. However, evidence from electrophysiological and imaging studies suggest that ipsilateral tracts may contribute to functional recovery after unilateral brain damage. This randomized-sham control study aims to explore to what extent ipsilateral tracts from the undamaged hemisphere may strengthen corticospinal control onto spinal motor networks following stroke. MethodsAnodal transcranial direct current stimulation (tDCS) was combined with monosynaptic H-reflex method to evaluate the variations of reciprocal inhibition (RI) in wrist flexors in 21 stroke participants. ResultsAnodal tDCS decreased RI in wrist flexors in stroke participants in both arms. tDCS unmasks an ipsilateral control from the undamaged hemisphere onto spinal motor networks controlling affected arm muscles in stroke participants. In the unaffected (contralateral) arm, effects in stroke participants were opposite to those induced in healthy subjects. ConclusionsStimulation of the undamaged cortex in stroke participants induces modulation of ipsilateral motor networks controlling the hemiparetic side. SignificanceRehabilitation could leverage stimulation of the undamaged hemisphere to enhance motor recovery post stroke.

Electroneurographic Evaluation of Neural Impulse Transmission in Patients after Ischemic Stroke Following Functional Electrical Stimulation of Antagonistic Muscles at Wrist and Ankle in Two-Month Follow-Up.

The available data from electroneurography (ENG) studies on the transmission of neural impulses in the motor fibers of upper and lower extremity nerves following neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy in post-stroke patients during sixty-day observation do not provide convincing results. This study aims to compare the effectiveness of an NMFES of antagonistic muscle groups at the wrist and ankle and kinesiotherapy based mainly on proprioceptive neuromuscular facilitation (PNF). An ENG was performed once in a group of 60 healthy volunteers and three times in 120 patients after stroke (T0, up to 7 days after the incident; T1, after 21 days of treatment; and T2, after 60 days of treatment); 60 subjects received personalized NMFES and PNF treatment (NMFES+K), while the other 60 received only PNF (K). An ENG studied peripheral (M-wave recordings), C8 and L5 ventral root (F-wave recordings) neural impulse transmission in the peroneal and the ulnar nerves on the hemiparetic side. Both groups statistically differed in their amplitudes of M-wave recording parameters after peroneal nerve stimulation performed at T0 and T2 compared with the control group. After 60 days of treatment, only the patients from the NMFES+K group showed significant improvement in M-wave recordings. The application of the proposed NMFES electrostimulation algorithm combined with PNF improved the peripheral neural transmission in peroneal but not ulnar motor nerve fibers in patients after ischemic stroke. Combined kinesiotherapy and safe, personalized, controlled electrotherapy after stroke give better results than kinesiotherapy alone.

Efficacy of Bilateral Lower Limb Training over Unilateral to Re-educate Balance and Walking in Post-stroke Survivors: A Protocol for Randomized Clinical Trial

Background: One of the significant causes of morbidity worldwide and an essential contributor to disability is Stroke. As said by the National Stroke Association, nine post-stroke survivors out of 10 experience some degree of weakness post-stroke. The hemiplegic patients with sub-acute stroke, who will undergo training to both the lower limb overtraining to only involved side will have an improvement in balance and walking. The goal of this study is to see how much training to both the lower limb improves functional recovery in patients who have had a subacute stroke compared to unilateral, more insufficient limb training.&#x0D; Objective: The goal of this study was to see how training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients.&#x0D; Methods: A randomized clinical study with assessor blinding will be conducted with participants with subacute stroke (n=40). Participants will be randomized to one of two groups after performing baseline assessments: Group A or Group B.1st group will receive training only to the hemiparetic side, i.e., Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation, and 2nd group participants will receive bilateral training, i.e., Strengthening to the unaffected side along with Motor Relearning Programme and Proprioceptive Neuromuscular Facilitation to the affected side. During the therapy period, we will assess lower limb function through static and dynamic balance, walking, and gait measures.&#x0D; Results: The purpose of the research is to look into the effect of training to both the lower limb overtraining to the hemiparetic lower limb on balance and walking in subacute stroke patients. The results of this study will be based on the outcome measures that are static and dynamic balance in the stroke patients and walking.&#x0D; Conclusion: The study's findings will shed more light on the benefits of training to both the lower limb overtraining to only involved side in patients post-stroke. If this trial proves successful, it will help post-stroke patients improve their balance and walking.

Efficacy of chest expansion resistance exercise on respiratory function, trunk control and dynamic balance in patients with chronic stroke: A Comparative study.

BackgroundMotor impairments caused by stroke result in impaired diaphragmatic and respiratory muscle function, changes in thoracic biomechanics on the hemiparetic side ultimately resulting in decreased efficiency of lung ventilation. This study aimed to examine the efficacy of chest expansion resistance exercise (CERE) on respiratory function, trunk control ability, and balance in patients with chronic stoke. Following a purposive sampling, thirty-five patients with chronic stroke were randomly allocated into two groups, i.e., the experimental group receiving CERE with conventional therapy and the control group receiving conventional therapy alone. Both the groups received therapy four times per week for a period of four weeks (total 16 sessions). Following assessments were done before and after treatment in both the groups: chest expansion ( axillary, nipple, xiphisternal levels) using measure tape, respiratory muscle strength using micro-respiratory pressure meter, trunk control using the Trunk Impairment Scale, and balance using mini-Balance Evaluation Systems Test.ResultsBoth groups had 17 participants each (n = 34, drop-outs = 1) consisting of 12 males and 5 females having a mean age of 56.5 ± 12.98 years and 59.7 ± 10.2 years, respectively. Intra-group analysis showed a statistically significant increase in mean values of chest expansion, respiratory muscle strength, trunk control ability, and balance in the experimental group whereas the control group showed improvement only in trunk control ability and balance. Inter-group comparison revealed a better improvement in all the outcome variables in experimental group compared to the control group.ConclusionsBased on these results, this study proved that CERE was more effective in improving respiratory function, trunk control, and balance in patients with chronic stroke.

Immediate Effect of Whole Body Vibration on Knee Extensor Tendon Stiffness in Hemiparetic Stroke Patients.

Background and Objectives: Whole body vibration is widely used to enhance muscle performance, but evidence of its effects on the tendon stiffness of the knee extensor tendon in stroke remains inconclusive. Our study was aimed to determine the difference in patellar and quadriceps tendon stiffness between hemiparetic and unaffected limbs in stroke patients and to investigate the immediate effect of whole body vibration on tendon stiffness. Materials and Methods: The patellar and quadriceps tendon stiffness of first-ever hemiplegic stroke patients was evaluated with elastography to compare the differences between hemiparetic and unaffected limbs. After one 20 min session of whole body vibration exercise in the standing position, tendon stiffness was again measured to evaluate the immediate effects of whole body vibration on tendon stiffness. Results: The results showed no significant differences in the tendon stiffness of the patellar and quadriceps tendons between hemiparetic and unaffected limbs. However, significant associations were found between the tendon stiffness of the patellar and quadriceps tendons and knee extensor spasticity on the hemiparetic side (ρ = 0.62; p = 0.044). There were no significant changes in tendon stiffness after a single session of whole body vibration. Conclusions: In conclusion, knee extensor tendon stiffness in hemiparetic limbs is positively correlated to the degree of knee extensor spasticity in stroke patients. However, a single session of whole body vibration does not alter tendon stiffness.

Mineralizing angiopathy with basal ganglia stroke after minor head trauma; a clinical profile and follow up study of a large series of paediatric patients from North India.

There is paucity of published literature on follow-up outcome of mineralizing angiopathy with basal ganglia stroke related to minor head trauma. This retrospective study aims to bridge this knowledge gap. Patients (1 months- 15 years), presenting with acute stroke over a 5-year period were recruited. From this cohort, basal ganglia strokes following minor head trauma were analysed in detail and outcome assessed using the Recovery and Recurrence Questionnaire (RRQ). A total of 94 patients were eligible, 48 (51%) were basal ganglia stroke following minor head trauma [M: F 2.5:1; mean age 21±8.5 (±SD months]. Further evaluation of this group revealed a median time of 60min (range 0-96h) from trauma to stroke onset. Nearly all had acute hemiparesis (45/48). Almost a third of patients (n=13; 27%) had a transient hemi dystonia on the hemiparetic side after a median of 4 days (range 2-6 days) of symptom onset.Computed tomography (CT) head showed bilateral basal ganglia calcification in all; Most patients (31/48; 64.5%) were anaemic. Magnetic Resonance (MR) angiography, echocardiogram and thrombophilia screen was normal wherever they were performed (6/48).The median follow-up period - 14 months (Range 0-22months). Majority of patients (22/35; 63%) showed complete recovery at 18 months follow up, with maximum recovery occurring between 6 and 12 months. Minor head trauma leading to basal ganglia stroke in children was the most common cause of paediatric stroke in our patients. In follow-up most patients had recovered fully, though a significant minority did not recover completely.

Rectus Femoris Characteristics in Post Stroke Spasticity: Clinical Implications from Ultrasonographic Evaluation.

In stroke survivors, rectus femoris (RF) spasticity is often implicated in gait pattern alterations such as stiff knee gait (SKG). Botulinum toxin type A (BoNT-A) is considered the gold standard for focal spasticity treatment. However—even if the accuracy of injection is crucial for BoNT-A efficacy—instrumented guidance for BoNT-A injection is not routinely applied in clinical settings. In order to investigate the possible implications of an inadequate BoNT-A injection on patients’ clinical outcome, we evaluated the ultrasound-derived RF characteristics (muscle depth, muscle thickness, cross-sectional area and mean echo intensity) in 47 stroke survivors. In our sample, we observed wide variability of RF depth in both hemiparetic and unaffected side of included patients (0.44 and 3.54 cm and between 0.25 and 3.16 cm, respectively). Moreover, our analysis did not show significant differences between treated and non-treated RF in stroke survivors. These results suggest that considering the inter-individual variability in RF muscle depth and thickness, injection guidance should be considered for BoNT-A treatment in order to optimize the clinical outcome of treated patients. In particular, ultrasound guidance may help the clinicians in the long-term follow-up of muscle quality.

Effects of the Immobilization of the Upper Extremities on Spatiotemporal Gait Parameters during Walking in Stroke Patients: A Preliminary Study

Background The purpose of this study was to investigate the effects of upper extremity immobilization and consequent walking speed on spatiotemporal gait parameters in stroke patients with hemiparesis. Methods The following variables were assessed or measured in 29 stroke patients: age, height, weight, disease duration, Korean version of the Mini-Mental State Examination (MMSE-K), Berg balance scale (BBS-K), functional gait assessment (FGA-K), cause of the disease (type of lesion), and hemiparetic side. The measurement of gait was performed using two pressure plates of 1.5 m to create a 3 m walking distance and leaving 1.5 m of extension at both start and end, to ultimately create a 6 m walking distance that the patient could walk through. The following gait patterns were randomly selected based on card draws: self-selected walk speed (SW), self-selected walk speed with immobilized upper extremities (SWI), fast walking (FW), and fast walking with immobilized upper extremities (FWI). Each patient was assessed for four different gait patterns, with three measurements per pattern (12 gait measurements in total). Results While there were significant differences in the stride length, step width, velocity, and step length of the paretic side between self-selected walk speed (SW) and SWI, FWI did not show significant changes in any of the tested parameters. Conclusions Immobilization of the upper extremities may affect walking at self-selected walk speeds. A comprehensive training program including upper extremity movement should be established for gait rehabilitation. Clinical Trial Registration. This trial is registered at http://cris.nih.go.kr/cris.

0684 Overnight Fluid Shift In Apnea And Stroke: Does Being Physically Active Matter

Abstract Introduction Obstructive sleep apnea (OSA) and physical inactivity are frequent in patients with stroke. Overnight fluid shift may increase the propensity to pharyngeal obstruction and thus predispose to OSA. Also, physical inactivity can lead to consequent edema in the hemiparetic side. Methods In 7 patients at 3 months following post-first-ever ischemic stroke, we measured change in AHI (PSG), neck circumference, and arms and legs fluid volume (bioelectric impedance), before and after PSG in two conditions during the day before PSG: (1) inactive (sitting/lying), and (2) physically active (standing, walking, climbing stairs and mild exercise for 30 mins/hour). Results Being physically active for one day decreased mean AHI (inactive: 17.9/h; active: 12.6/h). Mean neck circumference increased overnight in both conditions (active and inactive) but increased more when the participants were physically active (inactive: 38 to 38.5cm; active: 38.43 to 39.5cm). Mean paretic arm fluid volume increased after inactive condition and did not change after physically active condition (inactive: 1.33L to 1.45L; active: 1.82L). Mean non-paretic arm fluid volume increased after active and inactive conditions (inactive: 1.34L to 1.45L; active: 1.74 to 1.78L). In both conditions and for paretic and non-paretic arms, being physically active for one day increased arm fluid volume between pre- and post-sleep comparisons. Mean paretic leg fluid volume increased after both conditions but increased more when the participants were inactive (inactive: 6.08L to 6.52L; active: 6.12 to 6.24L). Mean non-paretic leg fluid volume increased after inactive condition and decreased after being physically active (inactive: 6.01L to 6.45L; active: 6.15 to 6.06L). Conclusion Being physically active for one day decreased AHI, despite the increased fluid accumulation in the neck, and contributed to leaving no edema in the hemiparetic side. Breaking up inactivity and increasing physical activity in patients following stroke may be a promising intervention to reduce edema and OSA. Support São Paulo Research Foundation (FAPESP, grant #2018/18952-1 to CF).

Effectiveness of visual feedback and postural balance treatment of post-stroke pusher syndrome. A systematic review

IntroductionPusher syndrome is characterised by the patient pushing towards the hemiparetic side with the contralateral side, in a sitting position, standing and during movement, surpassing the gravitational mean line, which produces inappropriate adjustment and postural control. ObjectiveTo determine the effectiveness of physiotherapy treatment in post-stroke pusher syndrome and to extract guidelines for its correct identification and interdisciplinary approach. MethodA systematic review was carried out (2000–2019), using the specialised databases MEDLINE, Scopus, PEDro and Web of Science. The descriptors used in the search strategies were “pusher syndrome”, “pushing behaviour”, “controversial pushing”, treatment, “physical therapy”, physiotherapy. ResultsAlthough the evidence is still limited, the intensive intervention of Physiotherapy in the patient with pusher syndrome post-stroke seems to improve the clinical symptoms in terms of severity and postural control. Among the different forms of treatment, training through visual feedback seems to be effective, especially using the Nintendo Wii balance platform. ConclusionAn individualised physiotherapeutic intervention with each patient is necessary to facilitate and guide the most effective motor strategies, work synergies between the members of the interdisciplinary team are essential (with specific guidelines on transfers and functional activities between sessions) to ensure continuity of care that guarantees achievements are maintained.