Hemiplegic Stroke Patients Research Articles

EFFECT OF VIBRATION STIMULUS ON SPASTICITY IN POST STROKE HEMIPLEGIC PATIENTS

Physical treatment such as vibration has been proposed as possible non-pharmacological way to control spasticity. The aim of the study was 1) can a selective vibration of the lower limb Dorsiexors of foot and quadriceps, reduce the spasticity of the plantar exors and hamstrings muscle; 2) is vibrations association with physiotherapy better than physiotherapy alone in reducing spasticity. This was a Pre Post study design wherein all the patients were taken from OPD in Govt. Medical College & Hospital, Sector 32 Chandigarh, India. Atotal of Sixty post stroke hemiplegic patients were taken for the study. Method. (VIB + PT) group A received physiotherapy plus vibration by means of a hand held vibrator applied over the belly of the Dorsiexors of leg and belly of Quadriceps muscle of the spastic side (contact surface 2 cm2; frequency 100 Hz; amplitude 2 mm; mean pressure 250 mBar). Control group B received conventional physiotherapy treatment alone. Both groups had 45 minutes of physiotherapy including Bobath therapy, muscle lengthening stretching exercises for 5 days a week for 2 weeks.Main Outcome Measure was Spasticity measurement by Modied Ashworth scale for both the groups before starting treatment and after the end of 2 weeks. Results: Fisher's exact test showed a statistically non signicant improvements in the (VIB + PT) group (p≥0.05) compared to in the (PT) group after 2 weeks of treatment for the Modied Ashworth scale. AlthoughStuart Maxwell Test showed that there was a statistically signicant difference within Group A i.e. Vibration plus Conventional physiotherapy with (p≤0.05) Conclusion. 1) 100 Hz vibration applied to the Dorsiexors of foot and Quadriceps muscle of a spastic lower limb in association with physiotherapy is able to reduce the spasticity of the exor agonist i.e. plantar exors and hamstrings 2) this association is not better than physiotherapy alone in controlling spasticity. Clinical Rehabilitation Impact :100 Hz antagonist muscle vibration, a non-pharmacological treatment, can help physiotherapy to reduce exors spasticity in the rehabilitation of lower limb spasticity.

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.

Effects of Functional Electrical Stimulation (FES) on the Temporal-spatial Gait Parameters and Activities of Daily Living in Hemiplegic Stroke Patients

Effects of Functional Electrical Stimulation (FES) on the Temporal-spatial Gait Parameters and Activities of Daily Living in Hemiplegic Stroke Patients

Effect of Kinesiology Taping of the Middle Back on Static Balance in Hemiplegic Stroke Patients: A Pilot Study

Effect of Kinesiology Taping of the Middle Back on Static Balance in Hemiplegic Stroke Patients: A Pilot Study

Prediction of Motor Function in Stroke Patients Using Machine Learning Algorithm: Development of Practical Models

BackgroundMachine learning (ML) techniques are being increasingly adopted in the medical field. ObjectiveWe developed a deep neural network (DNN) model and applied 2 well-known ML algorithms, logistic regression and random forest, in predicting motor outcome at 6 months after stroke. MethodsIn the present study, by using 14 input variables which are easily measured by clinicians, we developed ML models and investigated their applicability to predicting motor outcome in hemiplegic stroke patients. We retrospectively analyzed data of 1,056 consecutive stroke patients. Favorable outcomes of the upper and lower limbs were defined as a modified Brunnstrom classification (MBC) score of ≥5 (able to perform activities of daily living with the affected upper limb) and a functional ambulation category (FAC) score of ≥4 (able to walk without guardian's assistance), respectively. Poor outcomes of the upper and lower limbs were defined as MBC and FAC scores of <5 and <4, respectively. We developed 3 ML algorithms, namely the DNN, logistic regression, and random forest. ResultsRegarding the prediction of upper limb function, for the DNN model, the area under the curve (AUC) was 0.906. For the logistic regression and random forest models, the AUC were 0.874 and 0.882, respectively. For the prediction of lower limb function, for the DNN, logistic regression, and random forest models, the AUCs were 0.822, 0.768, and 0.802, respectively. ConclusionsWe demonstrated that the ML algorithms, particularly the DNN, can be useful for predicting motor outcomes in the upper and lower limbs at 6 months after stroke.

Association between trunk core muscle thickness and functional ability in subacute hemiplegic stroke patients: an exploratory cross-sectional study

ABSTRACT Back ground Balance impairment could occur due to weakness of the core muscles in stroke patients. Objective To investigate the association between functional ability, including trunk balance and core muscle thickness using ultrasonography in subacute hemiplegic stroke patients. Methods The muscle thickness of the anterior and posterior trunk muscles was measured using ultrasonography. For the evaluation of trunk balance, trunk impairment scale and Berg balance scale (BBS) were used. The functional ambulatory scale (FAS), timed up-and-go test, 10 m gait velocity, functional reach (FR), and functional independence measure were also assessed for functional ability. Results Overall, 41 patients with subacute hemiplegic stroke were included. Partial correlation analysis showed that posterior trunk muscle thickness was significantly correlated with BBS, FAS, and FR. As for the paralytic side, the posterior trunk muscle thickness of both paretic and nonparetic sides presented a significant relationship with BBS, FAS, and FR. The quadratus lumborum (QL) thickness of both sides showed a significant relationship with BBS, FAS, and FR. Conclusions The thickness of the posterior trunk muscles, especially the QL, on both the paretic and nonparetic sides, was significantly related with the functional ability after stroke. The exercise program of core posterior trunk muscles closely related with functional ability would be helpful to improve trunk balance and ambulatory function in subacute stroke patients.

Designing and Analyzing 3D-Printed Personal Steering Controller for Outdoor Electric-Powered Wheelchair Users: A Randomized Controlled Trial on Stroke Patients

While the physical conditions of stroke patients are diverse, the joystick-type steering controller of the electric-powered wheelchair (EPW) is almost the same, making the user uncomfortable and not fully utilizing the function of the wheelchair. The purpose of this study was to investigate the effects of the EPW steering controller, specifically the so-called joystick type (3DSC; 3D-printed steering controller, conventional steering controllers; CSC), on surface electromyography (sEMG), Wheelchair Skills Test 4.2 (WST), and QUEST 2.0. The participants were 23 hemiplegic stroke patients (14 males and 9 females) (range 40–65 years) recruited from multi-center process. The 3DSC manufacturing process used a scanner (Precision Laser Probe SLP-500) and a modelling program (SOLIDWORKS 2015). The CSC users’ muscle activities were generally higher than those of the 3DSC users in both males and females (p &lt; 0.05). WST total performance score of CSC is statistically significantly lower than those of 3DSC for both males (3DSC = 49.28 ± 2.19; CSC = 42.85 ± 4.31) (z = −3.935; p &lt; 0.05) and females (3DSC = 48.17 ± 0.44; CSC = 41.11 ± 0.78) (z = −1.910; p &lt; 0.05). QUEST 2.0 scores in CSC (male = 2.40 ± 0.70; female = 2.11 ± 0.78) were significantly lower than those of 3DSC (male = 3.50 ± 0.85; female = 2.90 ± 0.51) in effectiveness categories (p &lt; 0.05). We suggest that 3DSC contributes to reducing the user’s muscle activities and raising the scores of WST performance and QUEST.

Abstract P58: Motor Recovery After Chronic Stroke Correlates With Diffusion Tensor Measures of Ipsilesional Cerebral and Cerebellar White Matter Integrity

Introduction: We aimed to determine whether white matter (WM) tract integrity improved after a brain-computer interface (BCI) rehabilitation program for chronic stroke patients with upper extremity weakness. Mean diffusivity (MD) was calculated from diffusion tensor imaging (DTI) and is an indication of the integrity of axons and myelination in WM. MD is a biomarker in subacute stroke for post-stroke motor deficits and recovery. Methods: DTI scans were performed with 9 chronic hemiplegic stroke patients within 2 weeks of initiation and completion of a 12-week BCI rehabilitation program. All patients were a minimum of 6 months post-stroke. MD was then calculated using DSI-Studio for WM tracts in each patient at both pre- and post-therapy time points. Motor function was evaluated at these time points using the upper extremity portion of the Fugl-Meyer Assessment (UEFM). Voxelwise statistical analysis comparing pre- and post-intervention MD values was carried out using tract-based spatial statistics (TBSS). Relationships between MD measures in regions of interest and changes in motor function were estimated with Spearman correlations. Results: Voxelwise analysis using TBSS showed no significant group-level change in MD of WM tracts throughout the brain after completing BCI rehabilitation. However, the change in MD in ipsilesional cerebral WM was positively correlated with UEFM change (Spearman’s rho = 0.75, p = 0.02) as was the pre-BCI MD in the ipsilesional cerebellar WM (rho = 0.78, p = 0.01). The correlations between contralesional MD measures and UEFM change were not statistically significant. Conclusion: Correlation between changes in mean diffusivity of ipsilesional cerebral white matter and motor improvement in chronic stroke supports the literature that recovery may be mediated by axonal remyelination and regeneration. Furthermore, we find that pre-therapy, ipsilesional cerebellar white matter MD correlates with motor recovery and as such may serve as a predictive measure of the effectiveness of BCI therapy for patients.

Association Between Length of Stay in the Intensive Care Unit and Sarcopenia Among Hemiplegic Stroke Patients.

ObjectiveTo discuss the association between the length of stay at the intensive care unit (ICU) and sarcopenia among hemiplegic stroke patients.MethodsThis study evaluated 66 hemiplegic stroke patients with history of ICU admission using handgrip strength and bioelectrical impedance analysis to obtain height-adjusted appendicular skeletal muscle mass. The diagnosis of sarcopenia was made according to the muscle mass based on the Asian Working Group for Sarcopenia. The patients were divided into sarcopenic and non-sarcopenic groups. The two groups were statistically analyzed, and the significant factors with differences were studied. A multivariate logistic regression analysis was performed to examine the association between length of stay in the ICU and sarcopenia, after adjusting for potential confounders.ResultsAmong 66 hemiplegic patients with an ICU admission history, 12 patients were diagnosed with sarcopenia. Sarcopenia patients showed lower scores on the Korean version of the Modified Barthel Index and the Korean version of the Mini-Mental State Examination. Additionally, patients with sarcopenia had a longer length of stay in the ICU, and univariate and multivariate analyses confirmed that the ICU length of stay was significantly related to sarcopenia (adjusted odds ratio=1.187; 95% confidence interval, 1.019–1.382; p=0.028).ConclusionThe length of stay in the ICU was significantly associated with sarcopenia in hemiplegic stroke patients.

The parameters of gait analysis related to ambulatory and balance functions in hemiplegic stroke patients: a gait analysis study

BackgroundAmbulatory and balance functions are important for maintaining general health in humans. Gait analysis allows clinicians and researchers to identify the parameters to be focused on when assessing balance and ambulatory functions. In this study, we performed gait analysis with pressure sensors to identify the gait-analysis parameters related to balance and ambulatory functions in hemiplegic stroke patients.MethodsWe retrospectively reviewed the medical records of 102 patients with hemiplegic stroke who underwent gait analysis. Correlations between various temporospatial parameters in the gait analysis and the motor and balance functions assessed using functional ambulation category, modified Barthel index, and Berg balance scale were analyzed.ResultsGait speed/height and the lower-limb stance-phase time/height were the only temporal and spatial parameters, respectively, that showed a statistical correlation with motor and balance functions.ConclusionsMeasurements of walking speed and stance-phase time of the unaffected lower limb can allow clinicians to easily assess the ambulatory and balance functions of hemiplegic stroke patients. Rehabilitative treatment focusing on increasing gait speed and shortening the stance-phase time of the unaffected side may improve the ambulatory and balance functions in these patients.

Effect of the use of a body weight-supported walker on gait parameters in hemiplegic stroke patients

[Purpose] This study investigated gait parameter changes in hemiplegic stroke patients who walked with a body weight-supported (BWS) walker and evaluated the usefulness of using the BWS walker in a walking exercise. [Participants and Methods] Nineteen hemiplegic stroke patients hospitalized in a convalescent rehabilitation ward were enrolled in the study. Trunk acceleration was used to evaluate walking with and without a BWS walker. Gait speed, cadence, stride length, step time symmetry, stride time variability, and stride time regularity were calculated from the accelerometer waveform. [Results] Hemiplegic stroke patients had a faster gait speed, walked more symmetrically, and had less variation in their gait cycle when using the BWS walker than when not using it. [Conclusion] Using a BWS walker may help hemiplegic stroke patients learn to walk more efficiently in terms of their gait speed.

Knee joint movement and muscle activity changes in stroke hemiplegic patients on continuous use of knee-ankle-foot orthosis with adjustable knee joint.

[Purpose] We aimed to evaluate knee joint movement and muscle activity ratio changes in stroke hemiplegic patients in recovery phase after using a knee-ankle-foot orthosis with an adjustable knee joint for 1 month; we also aimed to discuss the practical implications of our findings. [Participants and Methods] The participants were 8 hemiplegic patients in the recovery phase of stroke who were prescribed knee-ankle-foot orthosis with adjustable knee joint. We measured knee joint angles and electromyographic activity of the vastus medialis and biceps femoris during walking in two conditions: the knee-ankle-foot orthosis knee joint fixed in the extended position and the knee joint moved from 0° to 30° in the flexion direction. Measurements were taken 2 weeks after completion to account for habituation of the orthosis and repeated 1 month later. [Results] When the knee joint was moving from 0° to 30° in the flexion direction, the knee joint angle at initial contact and the minimum flexion angle of the gait cycle decreased significantly between the first and second measurements. When knee joint flexion was 30°, the muscle activity ratio of the vastus medialis increased significantly in the loading response and mid-stance compared to when it was fixed. [Conclusion] Setting the knee joint of a knee-ankle-foot orthosis in accordance with the knee joint movement may increase the muscle activity ratio of the vastus medialis from loading response to mid-stance.

脳卒中片麻痺者における歩行パラメータと歩行立脚期足底圧との関係

脳卒中片麻痺者における歩行パラメータと歩行立脚期足底圧との関係

The use of walking assistance robot for hemiplegic stroke patient: A Case Report

The use of walking assistance robot for hemiplegic stroke patient: A Case Report

Effects of Gait Training Using Functional Electrical Stimulation of the Tibialis Anterior Muscle on the Gait Pattern of Convalescent Hemiplegic Stroke Patients

Effects of Gait Training Using Functional Electrical Stimulation of the Tibialis Anterior Muscle on the Gait Pattern of Convalescent Hemiplegic Stroke Patients

Effects of different baggage carrying methods on walking while wearing an arm sling in simulated hemiplegic stroke patients.

[Purpose] We aimed to clarify the effects of different baggage carrying methods on the movement of the trunk and pelvis while walking with an arm sling in simulated hemiplegic stroke patients. [Participants and Methods] The participants were 14 healthy young adults. Measurements were obtained using a three-dimensional motion analysis device in the following order: normal walking, walking with an arm sling on the upper left limb, walking with baggage on the right side, vertical walking, and diagonal walking. The range of motion of the trunk and pelvis during one walking cycle was analyzed. [Results] The range of motion of the lateral tilt of the pelvis significantly differed between normal and vertical walking, as well as between normal walking and diagonal walking. A significant difference was observed in the range of movement in pelvic rotation during the three walking cycles—walking with baggage, vertical walking, and diagonal walking. The range of movement in pelvic rotation was seemingly smaller under other conditions compared to that in normal walking. [Conclusion] It was shown that walking with restrictions on the upper limbs, such as wearing an arm sling or carrying baggage, may impose slight restrictions on the lateral tilt as well as on the rotation of the pelvis.

Effect of Provision of Knee-Ankle-Foot-Orthosis on the Gait Ability of Hemiplegic Stroke Patients at the Time of Discharge from a Convalescent Rehabilitation Ward in an Acute Care Hospital

Effect of Provision of Knee-Ankle-Foot-Orthosis on the Gait Ability of Hemiplegic Stroke Patients at the Time of Discharge from a Convalescent Rehabilitation Ward in an Acute Care Hospital

A kinematic analysis of after-effects of walking exercise using the walking assist device ACSIVE on the walking of a hemiplegic stroke patient

A kinematic analysis of after-effects of walking exercise using the walking assist device ACSIVE on the walking of a hemiplegic stroke patient

Performance Evaluation of Waist Guiding Control Method for Self-Standing-Up Training Support Robot

This paper proposed a self-standing-up training support robot that supports the patient's movements instead of the therapist for hemiplegic stroke patients. The robot consists of two passive robots with ER fluid brakes. We proposed a waist guiding control method that allows the patient to stand up and sit down. Two robots attached to the patient’s waist guide the patient’s waist in the left-right, roll, and yaw directions as the therapist. Moreover, the effectiveness of the proposed control method was evaluated from the view point of the maximum constraint force required at the end-effector and the virtual spring characteristics of the end-effector.

Evaluation of the Effect of Walking Exercise Using an Ankle Foot Orthosis with Electric Assistance for Chronic Hemiplegic Stroke Patients

Evaluation of the Effect of Walking Exercise Using an Ankle Foot Orthosis with Electric Assistance for Chronic Hemiplegic Stroke Patients