Paretic Muscle Strength Research Articles

THE EFFECT OF THE REHABILITATION AND PHYSICAL THERAPY PROGRAM ON THE FUNCTIONAL STATUS OF POST-STROKE PATIENTS

The article examines the impact of a physical rehabilitation program on the functional state of the musculoskeletal system in elderly patients who have suffered an intracerebral stroke and are in the conditions of a neurorehabilitation center in the early post-stroke period. Before the implementation of the program, post-stroke patients have pronounced walking disorders and a pronounced dependence on external assistance. The aim of the articale is to reveal the effectiveness of the physical rehabilitation program for post-stroke patients in the early recovery period. Results. Features of hemodynamic adaptation in post-stroke patients in the conditions of the rehabilitation center were revealed. Conclusion. As a result of the research, it was found that post-stroke patients had concomitant diseases: chronic heart failure and arterial hypertension in all studied patients, diabetes – in 20% of patients. All these conditions were taken into account during the selection of optimal means of the program physical rehabilitation. After completing the program, patients became more independent and needed less daily assistance, and also mastered such a vital and necessary skill as walking. This is confirmed by tests of functional status (Bartel index, Rivermead) and assessment of independent walking (Hauser walking index). The level of disability according to the Rankin scale decreased by 20%, the Rivermead mobility index increased by 50.6%, the Barthel index of daily activity increased by 13.5%, the Hauser walking index increased by 31.8%, the range of motion in the joints of the limbs also increased, the level of spasticity according to the modified Ashworth scale decreased by 22.5% in the in the upper and lower extremities, the strength according to the MRCS scale increased, in the extremities by 20%. Thus, after completing the rehabilitation program, all patients observed a increase in paretic muscle strength, decreased muscle spasticity tone, and improved range of motion in the joints. Implementation of the physical rehabilitation program resulted in a significant increase in MRCS muscle strength in the limbs by 20% (p < 0.01). After completing the program, patients became more independent and needed less daily assistance, as well as mastered such a vital and necessary skill as walking. This is confirmed by tests of functional status (Bartel index, Rivermead) and assessment of independent walking (Hauser walking index). The level of disability according to the Rankin scale decreased by 20%, the Rivermead mobility index increased by 50.6%, the Barthel daily activity index increased by 13.5%, the Hauser walking index increased by 31.8%, the range of motion in the joints of the upper and of the lower limbs also increased, the level of spasticity according to the modified Ashworth scale decreased by 22.5% in the upper limb and by 20% in the upper and of the lower limbs, the strength according to the MRCS scale increased, in the limbs by 20%. Patients were able to move with little resistance. The effect of the rehabilitation program and physical therapy is evident in the increase in paretic muscle strength, reduction in spasticity, and increase in joint range of motion. Most patients regained the ability to walk, which contributed to increasing their level of independence. In general, the research results obtained after the implementation of the selected means of physical rehabilitation indicate the effectiveness of such a program.

Abstract 60: Ischemic Conditioning Improves Brachial Artery Flow Mediated Dilation in Chronic Stroke Survivors

Introduction: Brachial artery flow mediated dilation (FMD) is a well-established measure of vascular endothelial health and is pathologically low in chronic stroke survivors. Ischemic conditioning (IC) is a cardioprotective stimulus and has been shown to improve FMD and enhance motor function in healthy humans. We recently showed that IC can improve paretic muscle strength and increase self-selected walking speed in stroke survivors. These improvements could be, in part, mediated by improved peripheral vascular function and increased blood flow to the exercising muscle. The effects of IC on vascular endothelial function post-stroke have not been investigated. Hypothesis: Two weeks of IC on the paretic leg of chronic stroke survivors will improve FMD in the non-paretic brachial artery. Methods: This was a prospective, randomized, blinded and controlled pilot study. Twenty chronic stroke survivors (>1-year post-stroke) received either IC (cuff inflation on the paretic leg for five minutes to 225 mmHg) or Sham IC (cuff inflation to 10 mmHg) every other day for two weeks (five on-off cycles per session). Brachial artery FMD was assessed using ultrasonography within 48 hours of the beginning and end of the intervention period. Results: Eight men and twelve women participated in this study. The mean age was 59 ± 16 years and the mean time post-stroke was 9 ± 9 years. Brachial artery FMD increased in the IC group from 6.2 ± 4.9% to 8.9 ± 3.9% (n=10; p=0.023, 2-way Repeated Measures ANOVA) while no change was observed in the Sham IC group (pre- vs. post = 3.8 ± 3.9% vs. 2.7 ± 3.1%, respectively; p=0.32, n=10). Expressed as the mean change in FMD, IC increased FMD by 2.8 ± 3.7% while no change was observed in the Sham IC group (delta FMD = -1.1 ± 3.4%; p=0.024 IC vs. IC Sham, unpaired t-test). Conclusions: Two weeks of IC increases brachial artery FMD in chronic stroke survivors. Taken together with our previous work that shows IC increases paretic muscle strength and walking speed in chronic stroke survivors, IC has the potential to improve both motor and cardiovascular function post-stroke. Future larger studies are needed to evaluate the efficacy of IC to improve stroke recovery and to identify the pathways involved which confer benefit to both the nervous and cardiovascular systems.

Two weeks of ischemic conditioning improves walking speed and reduces neuromuscular fatigability in chronic stroke survivors.

This pilot study examined whether ischemic conditioning (IC), a noninvasive, cost-effective, and easy-to-administer intervention, could improve gait speed and paretic leg muscle function in stroke survivors. We hypothesized that 2 wk of IC training would increase self-selected walking speed, increase paretic muscle strength, and reduce neuromuscular fatigability in chronic stroke survivors. Twenty-two chronic stroke survivors received either IC or IC Sham on their paretic leg every other day for 2 wk (7 total sessions). IC involved 5-min bouts of ischemia, repeated five times, using a cuff inflated to 225 mmHg on the paretic thigh. For IC Sham, the cuff inflation pressure was 10 mmHg. Self-selected walking speed was assessed using the 10-m walk test, and paretic leg knee extensor strength and fatigability were assessed using a Biodex dynamometer. Self-selected walking speed increased in the IC group (0.86 ± 0.21 m/s pretest vs. 1.04 ± 0.22 m/s posttest, means ± SD; P < 0.001) but not in the IC Sham group (0.92 ± 0.47 m/s pretest vs. 0.96 ± 0.46 m/s posttest; P = 0.25). Paretic leg maximum voluntary contractions were unchanged in both groups (103 ± 57 N·m pre-IC vs. 109 ± 65 N·m post-IC; 103 ± 59 N·m pre-IC Sham vs. 108 ± 67 N·m post-IC Sham; P = 0.81); however, participants in the IC group maintained a submaximal isometric contraction longer than participants in the IC Sham group (278 ± 163 s pre-IC vs. 496 ± 313 s post-IC, P = 0.004; 397 ± 203 s pre-IC Sham vs. 355 ± 195 s post-IC Sham; P = 0.46). The results from this pilot study thus indicate that IC training has the potential to improve walking speed and paretic muscle fatigue resistance poststroke. NEW & NOTEWORTHY This pilot study is the first to demonstrate that ischemic conditioning can improve self-selected walking speed and reduce paretic muscle fatigue in stroke survivors. Ischemic conditioning has been shown to be safe in numerous patient populations, can be accomplished at home or at the bedside in only 45 min, and requires no specialized training. Future larger studies are warranted to determine the efficacy of ischemic conditioning as a neurorehabilitation therapy poststroke.

Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial.

The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enhances motor learning, neural reorganization and cortical activation in stroke. The efficacy of MI training involving lower extremity mobility tasks need to be assessed. To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects. A Randomized Clinical Trial was conducted in Department of Physical Therapy, Tertiary Care Hospitals, Mangalore, India which includes 40 hemi paretic subjects (>3 months post-stroke) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and randomly allocated into task-oriented training group (n=20) and task-oriented training group plus MI group (n=20). Subjects in both groups underwent task orientated training for lower extremity 45-60 minutes, 4 days per week for 3 weeks. In addition, the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice. Isometric muscle strength of Hip, Knee and Ankle using a hand-held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention. Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p <.05. The experimental group had shown a significant improvement in paretic hip muscles (both flexors and extensors), knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses. Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients.

Muscle strength and weight-bearing symmetry relate to sit-to-stand performance in individuals with stroke

This study investigated the relationship of lower extremity joint torques and weight-bearing symmetry to sit-to-stand (STS) performance in individuals with chronic stroke. A motion analysis system and two force plates measured STS duration and weight-bearing symmetry (determined by ground reaction forces) during three self-paced and three fast-paced conditions. An isokinetic dynamometer measured maximum concentric joint torques of the paretic and non-paretic ankle, knee, and hip, which were normalized by body mass. Pearson correlations indicated that (a) paretic ankle dorsiflexion and knee extension torques related to the duration of the self-paced STS condition (r = -0.450, -0.716, respectively), (b) paretic ankle dorsiflexion, plantar flexion, and knee extension torques related to the duration of the fast-paced STS condition (r = -0.466, -0.616, -0.736, respectively), and (c) greater weight-bearing symmetry related to faster STS performance for both self-paced and fast-paced STS conditions (r = -0.565, -0.564, respectively) (P < 0.05). This evidence suggests that paretic muscle strength and the ability to load the paretic limb are important factors underlying the ability to rise from a chair in individuals with chronic stroke.

Isocinétisme et rééducation de la marche de l’hémiplégique

Purpose: Determine the effects of training with isokinetic maximal eccentric knee extension and flexion on the gait velocity and steps in hemiparetic patients. Subjects: Ten hemiparetic subjects were included in this study. All of the subjects participated in a conventional therapeutic exercise program and gait training for six weeks. The ten patients also received isokinetic training on the hemiparetic and safely side the Biodex machine at speeds of 60, 120 and 150°/s as part of their program, thrice a week during six weeks. Results: Paretic muscle strength improved after training while tone remained consistent. Gait velocity increased in all patients. The subjects improved the ability for steps. Conclusions: The results are encouraging and give support for use eccentric isokinetic training in hemiparetic patients in association with conventional therapy.

Isocinétisme et rééducation de la marche de l'hémiplégique

Purpose Determine the effects of training with isokinetic maximal eccentric knee extension and flexion on the gait velocity and steps in hemiparetic patients. Subjects Ten hemiparetic subjects were included in this study. All of the subjects participated in a conventional therapeutic exercise program and gait training for six weeks. The ten patients also received isokinetic training on the hemiparetic and safely side the Biodex machine at speeds of 60, 120 and 150 °/s as part of their program, thrice a week during six weeks. Results Paretic muscle strength improved after training while tone remained consistent. Gait velocity increased in all patients. The subjects improved the ability for steps. Conclusions The results are encouraging and give support for use eccentric isokinetic training in hemiparetic patients in association with conventional therapy.

Isokinetic strength training of the hemiparetic knee: Effects on function and spasticity

Purpose: To determine whether isokinetic training can improve the strength of the hemiparetic knee musculature, functional mobility, and physical activity and to evaluate its effect on spasticity in long-term stroke survivors. Design: Nonrandomized self-controlled trial. Subjects: A volunteer sample of 15 community-dwelling stroke survivors of at least 6 months. Intervention: A 6-week (3 days/week, 40 minutes/day) program consisting of warm-up, stretches, reciprocal knee extension and flexion isokinetic strengthening, and cool-down for the paretic limb. Main Outcome Measures: Peak isokinetic hamstring and quadriceps torque, quadriceps spasticity, gait velocity, timed Up and Go, timed stair climb, and the Human Activity Profile (HAP) scores were recorded at baseline, after training, and 4 weeks after training cessation (follow-up). Results: Paretic muscle strength improved after training ( p < .05) while tone remained consistent ( p > .87). Gait velocity increased after training ( p < .05) and at follow-up ( p < .05). Changes in stair climbing and timed Up and Go were not significant ( p > .37; p > .91), although subjects perceived gains in their physical abilities at follow-up ( p < .01). Conclusions: Gains in strength and gait velocity without concomitant increases in muscle tone are possible after a shortterm strengthening program for stroke survivors. The psychological benefit associated with physical activity is significant.

Strength Deficits Also Predict Gait Performance in Patients with Stroke

Measurements of muscle strength have been clearly established as predictors of gait performance in patients with stroke. By examining the previously published data, strength deficits of the paretic side of 26 patients with stroke are also shown to correlate with gait performance (speed [r = -.638]). Paretic muscle strength deficits, then, may also be considered valid predictors of gait performance.

Association of paretic lower extremity muscle strength and standing balance with stair-climbing ability in patients with stroke

The purpose of this study was to investigate the relationship between stair-climbing ability and standing balance and paretic lower extremity muscle strength in a sample of subjects following stroke. The subjects were 20 patients with hemiparesis and intact sensation who were a mean 67 years of age and 48 days post-stroke. Stair-climbing ability was measured using a three-component (assistance, rail use, pattern) grading system from which a total score was derived. The strength of five muscle groups was measured with a hand-held dynamometer. The sum of the five muscle group strengths was calculated. Standing balance was measured using an ordinal grading scheme. Individual muscle group strengths as well as the sum of the muscle group strengths were correlated significantly with the total stair-climbing scores (rs = 0.734 - 0.860). Standing balance scores correlated significantly with the total stair-climbing scores (rs = 0.937). Multiple regression showed that standing balance alone explained stair-climbing ability as well as stair-climbing ability and muscle strength combined. The results reinforce that both paretic muscle strength and standing balance may be appropriate components of the assessment and potentially fruitful targets for treatment for patients with stroke.