Paretic Side Research Articles

Application of Ilizarov transverse tibial bone transport and microcirculation reconstruction in the treatment of chronic ischemic diseases in lower limbs.

The aim of the present study is to investigate the clinical value of Ilizarov transverse tibial bone transport and microcirculation reconstruction in the treatment of chronic ischemic diseases in lower limbs. A total of 90 patients with chronic ischemic diseases in lower limbs were selected and randomly divided into two groups: The observation group (n=45) and the control group (n=45). Those patients were treated with Ilizarov transverse tibial bone transport and microcirculation reconstruction, and percutaneous balloon angioplasty (PTBA), respectively. Changes in the diameter, blood flow of lower limb arteries in the paretic side, wound healing time, disappearance time of pains, dorsal foot skin temperature, and the expression area of vascular endothelial growth factors (VEGFs) were detected in both groups. Compared with control group, the diameters and blood flows of lower limb arteries were significantly larger (P<0.05), and the dorsal foot skin temperature was significantly higher at 1 day, 1 week and 1 month after operation, respectively. Meantime, the expression area of VEGFs in the observation group was significantly larger than that in the control group at 1 day, 1 week and 1 month, respectively. Furthermore, compared with control group, wound healing time and disappearance time of pains of patients were earlier in the observation group (P<0.05). At 1 month after operation, the intermittent claudication, rest pain and lower limb ulcer or gangrene among clinical symptoms of patients in the observation group improved significantly more than those in the control group (P<0.05). In conclusion, the application of Ilizarov transverse tibial bone transport and microcirculation reconstruction could achieve better outcomes in the treatment of chronic ischemic diseases in lower limbs.

Myoelectric Pattern Recognition for Controlling a Robotic Hand: A Feasibility Study in Stroke.

Myoelectric pattern recognition has been successfully applied as a human-machine interface to control robotic devices such as prostheses and exoskeletons, significantly improving the dexterity of myoelectric control. This study investigates the feasibility of applying myoelectric pattern recognition for controlling a robotic hand in stroke patients. Myoelectric pattern recognition of six hand motion patterns was performed using forearm electromyogram signals in paretic side of eight stroke subjects. Both the random cross validation (RCV) and the chronological handout validation (CHV) were applied to assess the offline myoelectric pattern recognition performance. Experiments on real-time myoelectric pattern recognition control of an exoskeleton robotic hand were also performed. An average classification accuracy of 84.1% (the mean value from two different classifiers) and individual subject differences were observed in the offline myoelectric pattern recognition analysis using the RCV, while the accuracy decreased to 65.7% when the CHV was used. The stroke subjects achieved an average accuracy of 61.3 ± 20.9% for controlling the robotic hand. However, our study did not reveal a clear correlation between the real-time control accuracy and the offline myoelectric pattern recognition performance, or any specific characteristics of the stroke subjects. The findings suggest that it is feasible to apply myoelectric pattern recognition to control the robotic hand in some but not all of the stroke patients. Each stroke subject should be individually online tested for the feasibility of applying myoelectric pattern recognition control for robot-assisted rehabilitation.

A startling acoustic stimulus facilitates voluntary lower extremity movements and automatic postural responses in people with chronic stroke

A startling acoustic stimulus (SAS) involuntary releases prepared movements at accelerated latencies, known as the StartReact effect. Previous work has demonstrated intact StartReact in paretic upper extremity movements in people after stroke, suggesting preserved motor preparation. The question remains whether motor preparation of lower extremity movements is also unaffected after stroke. Here, we investigated StartReact effects on ballistic lower extremity movements and on automatic postural responses (APRs) following perturbations to standing balance. These APRs are particularly interesting as they are critical to prevent a fall following balance perturbations, but show substantial delays and poor muscle coordination after stroke. Twelve chronic stroke patients and 12 healthy controls performed voluntary ankle dorsiflexion movements in response to a visual stimulus, and responded to backward balance perturbations evoking APRs. Twenty-five percent of all trials contained a SAS (120 dB) simultaneously with the visual stimulus or balance perturbation. As expected, in the absence of a SAS muscle and movement onset latencies at the paretic side were delayed compared to the non-paretic leg and to controls. The SAS accelerated ankle dorsiflexion onsets in both the legs of the stroke subjects and in controls. Following perturbations, the SAS accelerated bilateral APR onsets not only in controls, but for the first time, we also demonstrated this effect in people after stroke. Moreover, APR inter- and intra-limb muscle coordination was rather weak in our stroke subjects, but substantially improved when the SAS was applied. These findings show preserved movement preparation, suggesting that there is residual (subcortical) capacity for motor recovery.

F75. Hybrid-Assistive-Neuromuscular-Dynamic-Stimulation (HANDS) therapy induces cortical sensory plasticity in patients with chronic stroke

Introduction The hybrid assistive neuromuscular dynamic-stimulation (HANDS) therapy is closed-loop electromyography-controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint for patients with moderate to severe hemiparesis even including chronic stroke. It is repeatedly reported HANDS therapy induce significant recovery in upper extremity motor function for relatively severe paresis with a minimal ability for volitional muscle activation, who do not meet the criteria for other intensive therapies such as constrained-induced movement therapy. Although almost the half of stroke survivors are suffering from somatosensory impairment, and it is indicated that the sensory recovery would have a certain beneficial impact on motor functional recovery, neither the detailed mechanisms of somatosensory recovery nor the interaction with motor recovery are not determined enough especially for chronic stroke. On these ground, we have investigated the effect of HANDS therapy on the feature of sensory recovery. Methods For 23 chronic stroke patients with hemiplegia, 3 weeks inpatient HANDS therapy intervention was taken place. Median and Tibial nerve Sensory Evoked Potential (SEP) and behavioral sensory assessments including Semmes-Weinstein monofilament test and thumb-localizing test were performed at pre and posttreatment, as well as the motor functional assessments. Results A significant increase in the number of SEP peaks in the Median nerve and a significant reduction in the latency gap between N20 and P45 were observed in the paretic side after the intervention, whereas no significant difference was observed in any of these behavioral assessments. Although motor functional recovery was observed as in the previous studies, there was no significant correlation detected between motor function and each sensory related indices including SEP peak number and behavioral assessments. Conclusion Our result firstly suggests that closed-loop electromyography-controlled NMES training induce a sort of plastic changes especially in the level of cortex even in the chronic stroke patients. SEP would be a good evaluation modality which has higher sensitivity to detect a smaller plastic change induced by rehabilitative intervention.

Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.

Ramsay Hunt syndrome (RHS) and Bell palsy (BP) are typically known as facial nerve motor syndromes and are primarily unilateral. The aim of this study was to challenge this assertion, because both conditions are also known to be associated with viruses that typically affect several nerves. Ten participants with RHS, 12 with BP, all clinically unilateral, and 12 healthy controls were prospectively enrolled. Electrogustometric thresholds were measured bilaterally in the areas of the chorda tympani, the glossopharyngeal, and the major petrosal nerve. Also bilaterally, the taste function was tested using chemogustometry with different tastant concentrations. Again bilaterally, the morphology of the mucosa and the vessels of the anterior fungiform papillae were examined by contact endoscopy. Statistically, RHS and BP participants were compared with the healthy controls, and the paretic sides of RHS and BP were compared pairwise with their mobile sides. Electrogustometrically, perception was reduced bilaterally in RHS (10-19dB, p < 0.001) and BP (3-5dB, p = 0.011-0.030) in all 3 innervation areas. Chemogustometrically, it was also reduced bilaterally in RHS (20-70%) and BP (8-50%). Papillary atrophies were increased 100% in RHS (p = 0.001) and BP (p < 0.001). They were more increased on the paretic side in RHS (30%, p = 0.078) and BP (83%, p < 0.001). In these 2 clinically unilateral conditions, the gustatory perception and morphology are bilaterally affected, more in RHS and more on the paretic side. BP, known as an isolated motor condition, appears to be a cranial polyneuritis. A bilateral examination and therapeutic gustatory monitoring might follow these observations in evidence-based practice. Ann Neurol 2018;83:807-815.

Regulation of quasi-joint stiffness by combination of activation of ankle muscles in midstances during gait in patients with hemiparesis

BackgroundThe regulation of ankle joint stiffness by combination of activation of plantarflexor and dorsiflexor during gait has not been investigated in patients with hemiparesis. The objective of the present study was to examine the relationship between combination of activation of ankle muscles and quasi-joint stiffness (QJS) during the stance phase of gait. MethodsThe activation of the medial head of the gastrocnemius (MG), soleus, and tibialis anterior, gait parameters were collected from 19 patients with hemiparesis due to stroke and from 12 healthy controls using a three-dimensional motion analysis system. The indexes of reciprocal activation and coactivation were calculated from the ratio of plantarflexor to dorsiflexor activation and magnitude of coactivation (MC), which is computed by multiplying an index of simultaneous activation of ankle muscles by plantarflexor activation. ResultsQJS was significantly correlated with MC of MG on the paretic side, whereas it correlated with the ratio of MG (r = 0.63, p < 0.05) in healthy controls and the ratio of MG (r = 0.67, p < 0.05) and soleus (r = 0.61, p < 0.05) on the non-paretic side in midstance. Furthermore, QJS on the paretic side was lower than that on the non-paretic side and in healthy controls (p < 0.05). SignificanceOur findings support that the regulation of QJS in midstance by reciprocal activation is altered on the paretic side, whereas it may be regulated by reciprocal activation and enhanced by relatively high activity of plantarflexor on the non-paretic side and in healthy controls.

Use of whole body vibration in individuals with chronic stroke: Transmissibility and signal purity

This study examined (1) the influence of whole body vibration (WBV) frequency (20 Hz, 30 Hz, 40 Hz), amplitude (low: 0.8 mm and high: 1.5 mm) and body postures (high-squat, deep-squat, tip-toe standing) on WBV transmissibility and signal purity, and (2) the relationship between stroke motor impairment and WBV transmissibility/signal purity. Thirty-four participants with chronic stroke were tested under 18 different conditions with unique combinations of WBV frequency, amplitude, and body posture. Lower limb motor function and muscle spasticity were assessed using the Fugl-Meyer Assessment and Modified Ashworth Scale respectively. Nine tri-axial accelerometers were used to measure acceleration at the WBV platform, and the head, third lumbar vertebra, and bilateral hips, knees, and ankles. The results indicated that WBV amplitude, frequency, body postures and their interactions significantly influenced the vibration transmissibility and signal purity among people with chronic stroke. In all anatomical landmarks except the ankle, the transmissibility decreased with increased frequency, increased amplitude or increased knee flexion angle. The transmissibility was similar between the paretic and non-paretic side, except at the ankle during tip-toe standing. Less severe lower limb motor impairment was associated with greater transmissibility at the paretic ankle, knee and hip in certain WBV conditions. Leg muscle spasticity was not significantly related to WBV transmissibility. In clinical practice, WBV amplitude, frequency, body postures need to be considered regarding the therapeutic purpose. Good contact between the feet and vibration platform and symmetrical body-weight distribution pattern should be ensured.

Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals

Gait asymmetry and dynamic balance impairments observed in post-stroke individuals increase their risk of fall. Moreover, walking while performing a cognitive task (i.e. dual-task) disturbs the control of balance in post-stroke individuals. Here we investigated the mediolateral dynamic stability in twenty-two community-dwelling participants (12 post-strokes and 10 healthy controls) while walking in single-task (normal gait) and four different dual-tasks (cognitive-motor interference). Positions of the extrapolated center of mass and mediolateral widths of both margin of stability and base of support were extracted from 35 marker trajectories. Post-stroke participants presented larger margin of stability and base of support than controls during single-task (both p < 0.01), with a larger margin of stability on the non-paretic side than on the paretic side at ipsilateral foot-strike (p < 0.05). No significant effect of the dual-task was found between groups. In post-stroke participants, dual-task induced slight modification of the mediolateral stability strategy, as the margin of stability was not different between the two limbs at foot-strike, and significantly reduced the performance in every cognitive task. Post-stroke participants increased their dynamic stability in the frontal plane in single-task by extending their base of support and mainly relying on their non-paretic limb. Under cognitive-motor interference (dual-task), post-stroke participants prioritized dynamic stability over cognitive performance to ensure a safe locomotion. Thus, rehabilitation programs should consider both dynamic balance and dual-task training, even at a chronic delay following stroke, to reduce the risk of fall in post-stroke individuals.

Examination of Factors Related to the Effect of Improving Gait Speed With Functional Electrical Stimulation Intervention for Stroke Patients

BackgroundFunctional electrical stimulation (FES) for patients with stroke and foot drop is an alternative to ankle foot orthoses. Characteristics of FES responders and nonresponders have not been clarified. Objectives(1) To investigate the effects of treatment with FES on patients with stroke and foot drop and (2) to determine which factors may relate to responders and nonresponders. DesignMulticenter, nonrandomized, prospective study. SettingMulticenter clinical trial. ParticipantsParticipants included those who experienced foot drop resulting from stroke, were older than 20 years, and could provide consent to participate; they were enrolled from hospitals between January 2013 and September 2015 and performed rehabilitation with FES. MethodsStroke Impairment Assessment Set Foot-Pat Test (SIAS-FP), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), Modified Ashworth scale (MAS) for ankle joint dorsiflexion and plantar flexion muscles, range of motion (ROM) for ankle joint, 10-m walking test (10mWT), Timed Up & Go test (TUG), and 6-minute walking test (6MWT) were evaluated pre- and postintervention. Age, gender, type of stroke, onset times of stroke, paretic side, Brunnstrom stage of the lower extremity (Br. stage-LE), Functional Independence Measure (FIM), Functional Ambulation Category (FAC), poststroke months, number of interventions, total hours of interventions, and whether a brace was used were extracted from patients’ medical records and collected on the physiological examination day. Main Outcome MeasurementsThe authors examined 10mWT and age, gender, type of stroke, onset times of stroke, paretic side, Br. stage-LE, FIM, FAC, poststroke months, number of interventions, total hours of interventions, whether a brace was used, SIAS-FP, FMA-LE, MAS, ROM, TUG, and 6MWT before intervention. Participants were divided into nonresponders and responders with a change in 10mWT of <0.1 and ≥0.1 m/s, respectively. Single and multiple regression analyses were used for data analysis. Additionally, the changes between groups were compared. ResultsFifty-eight responders and 43 nonresponders were enrolled. The between-group differences, compared for changes between pre- and postintervention, were significant in terms of changes in SIAS-FP (P = .02), 10mWT (P < .001), 10-m gait steps (P < .001), TUG (P = .04), and 6MWT (P = .006). In the adjusted regression model, gender (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.426-12.25; P = .007), number of interventions (OR, 1.028; 95% CI, 1.003-1.070; P = .03), and active ankle joint dorsiflexion ROM (OR, 1.047; 95% CI, 1.014-1.088; P = .005) remained significant. ConclusionThe factors related to 10mWT showing changes beyond the minimal clinically important difference were found to be patient gender, number of interventions, and active ankle joint dorsiflexion ROM before intervention. When patients with stroke who have greater active ankle joint ROM, and are female, use FES positively, they may benefit more from using FES. Level of EvidenceII

The effect of Thera-Band resistance strength training on motor function of lower limbs and gait after stroke

Objective To explore the effect of progressive strength training with TheraBand on lower limb motor function and gait after stroke. Methods Forty-eight hemiplegic stroke survivors were randomly divided into a treatment group and a control group, each of 24. The patients of both groups were provided with the routine rehabilitation training, while the treatment group additionally trained the muscles of the paretic side progressively using Thera-Band elastic belts. Before and after 8 weeks of treatment, both groups were evaluated using the Fugl-Meyer movement assessment (FMA), the Berg balance scale (BBS), and the walking and stair negotiation components of the functional independence measure (FIM). GaitWatch gait analysis was also performed. Results After the treatment, significant improvement was observed with both groups′ average FMA scores, BBS ratings, FIM scores, stride frequency, stride length and walking speed, but the treatment group showed significantly greater improvement than the control group, on average. Conclusion Using Thera-Band elastic belts to provide resistance can supplement routine rehabilitation training in improving motor function and walking ability after a stroke. Key words: Strength training; Stroke; Motor function; Gait analysis; Thera-Band

Factors affecting premature plantarflexor muscle activity during hemiparetic gait

In hemiparetic stroke survivors, premature plantarflexor muscle activity (PPF) often appears as a gait abnormality from terminal swing to the loading response on the paretic side. This study aimed to discern factors giving rise to PPF. Lower extremity function, spasticity magnitude, and gait electromyograms were assessed in 31 hemiparetic stroke survivors. Mean amplitudes during gait phases were determined for the paretic soleus, tibialis anterior, rectus femoris, and biceps femoris. The subjects were classified into PPF and non-PPF groups based on their relative soleus amplitude at different phases of gait, and group differences in each measurement were calculated and subjected to logistic regression. The PPF group showed less activity of the tibialis anterior during the swing phase but greater activity of the rectus femoris during the swing phase and of the biceps femoris, both prematurely and during the loading response. Logistic regression revealed premature activity of the biceps femoris to be a significant variable related to presence of PPF (odds ratio = 1.054). PPF in hemiparetic gait may work with the biceps femoris to supplement compromised lower extremity extension strength. PPF might be reduced by attaining enhanced strength of the hip and knee extensors at the time of initial contact during gait.

Bilateral changes in afterhyperpolarization duration of spinal motoneurones in post-stroke patients.

This paper extends the observations presented in the previously published work on the afterhyperpolarization (AHP) duration changes in motoneurones (MNs) on the paretic (more affected) side of 11 post-stroke patients by the same analysis on the non-paretic (less-affected) side. The estimated AHP duration for patients’ MNs supplying more-affected muscles was significantly longer than control values and the elongation decreased with patient age and disorder duration. For MNs supplying less-affected muscles, dependency of AHP duration on age was closer to the control data, but the scatter was substantially bigger. However, the AHP duration estimate of less-affected MNs tended to be longer than that of controls in the short time elapsed since the stroke, and shorter than controls in the long time. Our results thus suggest that the spinal MNs on both sides respond to the cerebral stroke rapidly with prolongation of AHP duration, which tends to normalize with time, in line with functional recovery. This suggestion is in concert with the published research on post-stroke changes in brain hemispheres. To our knowledge, these dependencies have never been investigated before. Since the number of our data was limited, the observed trends should be verified in a larger sample of patients and such a verification could take into account the suggestions for data analysis that we provide in this paper. Our data are in line with the earlier published research on MN firing characteristics post-stroke and support the conclusion that the MUs of the muscles at the non-paretic side are also affected and cannot be considered a suitable control for the MUs on the paretic side.

Surface Electromyographic Examination of Poststroke Neuromuscular Changes in Proximal and Distal Muscles Using Clustering Index Analysis.

Whether stroke-induced paretic muscle changes vary across different distal and proximal muscles remains unclear. The objective of this study was to compare paretic muscle changes between a relatively proximal muscle (the biceps brachii muscle) and two distal muscles (the first dorsal interosseous muscle and the abductor pollicis brevis muscle) following hemisphere stroke using clustering index (CI) analysis of surface electromyograms (EMGs). For each muscle, surface EMG signals were recorded from the paretic and contralateral sides of 12 stroke subjects versus the dominant side of eight control subjects during isometric muscle contractions to measure the consequence of graded levels of contraction (from a mild level to the maximal voluntary contraction). Across all examined muscles, it was found that partial paretic muscles had abnormally higher or lower CI values than those of the healthy control muscles, which exhibited a significantly larger variance in the CI via a series of homogeneity of variance tests (p < 0.05). This finding indicated that both neurogenic and myopathic changes were likely to take place in paretic muscles. When examining two distal muscles of individual stroke subjects, relatively consistent CI abnormalities (toward neuropathy or myopathy) were observed. By contrast, consistency in CI abnormalities were not found when comparing proximal and distal muscles, indicating differences in motor unit alternation between the proximal and distal muscles on the paretic sides of stroke survivors. Furthermore, CI abnormalities were also observed for all three muscles on the contralateral side. Our findings help elucidate the pathological mechanisms underlying stroke sequels, which might prove useful in developing improved stroke rehabilitation protocols.

Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

ObjectiveTo investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months. DesignLongitudinal study. SettingUniversity laboratory. ParticipantsAdults (N=75) recruited within 1 month of discharge home from inpatient stroke rehabilitation. InterventionsNot applicable. Main Outcome Measures36-Item Short Form Health Survey (SF-36) for HRQoL and Subjective Index of Physical and Social Outcome (SIPSO) for community reintegration. Physical performance measures were the 6-minute walk test, timed Up and Go (TUG) test, Berg Balance Scale, Community Balance and Mobility Scale, and isokinetic torque and power of hip, knee, and ankle on the paretic and nonparetic sides. Other prognostic variables included age, sex, stroke type and location, comorbidities, and motor FIM score. ResultsSeparate stepwise linear regressions were performed using the SF-36 and SIPSO as dependent variables. The total paretic lower limb torque and 6-minute walk test predicted the SF-36 Physical Component Summary (adjusted R2=.30). The total paretic lower limb torque and TUG test predicted the SIPSO physical component (adjusted R2=.47). The total paretic lower limb torque significantly predicted the SF-36 Mental Component Summary, but the adjusted R2 was low (.06). Similarly, the TUG test significantly predicted the SIPSO social component, but again the adjusted R2 was low (.09). ConclusionsMeasures of physical performance including muscle strength and mobility at discharge can partially predict HRQoL and community reintegration 6 months later. Further research is necessary for more accurate predictions.

Muscle Thickness and Echo Intensity of the Abdominal and Lower Extremity Muscles in Stroke Survivors.

Background and PurposeThis study compared the muscle thickness (MT) and echo intensity (EI) of the abdominal, thigh, and lower leg muscles between the paretic and nonparetic sides in chronic stroke survivors.MethodsThirty-two stroke survivors living in the community participated in this study. The MT and EI, which are indicators of muscle mass and intramuscular fat or connective tissue, were assessed in the rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius, vastus lateralis, vastus medialis, tibialis anterior, gastrocnemius, and soleus via transverse ultrasound imaging. In addition, a possible indicator of physical activity—the frequency of going out per week—was evaluated.ResultsAll quadriceps muscles and the tibialis anterior were significantly thinner and the EI values of the vastus intermedius, vastus lateralis, vastus medialis, and soleus were significantly higher in the paretic limb than the nonparetic limb. The MT and EI values of abdominal muscles did not differ significantly between the two sides. The MT values of the paretic rectus femoris, vastus lateralis, and vastus medialis were significantly associated with the frequency of going out after adjusting confounding factors. The MT of the nonparetic vastus lateralis was significantly associated with latency from stroke onset after adjusting confounding factors.ConclusionsOur results indicate that quantitative and qualitative changes on the paretic side in stroke survivors were the most robust in the thigh muscles, whereas such changes might not occur in the abdominal muscles.

The Effects of Scapula Setting Intervention on the ADL and gait in the Stroke Patients

Background/Objectives: In this study, we assessed the effects of scapula setting intervention on the ADL and gait in the stroke patients with hemiplegia. Methods/Statistical analysis: Thirty subjects with stroke patients participated. Subjects were randomly divided into scapula setting intervention group (n=15) and general physical therapy group (n=15) both therapy was applied for 30mins in a day and 3times in a week for 4 weeks. The TUG and MBI was used to evaluate gait, ADL by paretic side in stroke patients. To compare the treatments, we used paired t-test and independent sample t-test. Findings The scapula setting intervention group and general physical therapy group showed statically significant differences before and after the gait. The experimental group showed a more significant difference compared with the control group when TUG. However, there was no statistically significant difference MBI. Improvements/Applications: The scapula setting intervention was helpful more than the general physical therapy to improve in the stroke patients.

Effect of mirror use on lower extremity muscle strength of patients with chronic stroke.

[Purpose] This study examines the effect on muscle strength of lower extremity muscle strength exercise while using a mirror on the non-paretic side in patients with chronic stroke. [Subjects and Methods] Subjects were randomly assigned to a non-mirror lower extremity exercise group (n=10), a mirror lower extremity exercise group (n=10), or a mirror lower extremity muscle strength exercise group (n=10). Subjects were asked to do the exercise assigned to their group (5 sets 30 times a day, 5 times weekly for 4 weeks) with general physical therapy in the hospital. Muscle strength in the knee extensor and flexor of paretic and non-paretic side were measured using electrical muscle testing device before and after the intervention. [Results] Muscle strength significantly increased within each group after intervention. No significant differences were found among the three groups. [Conclusion] This study showed that the lower extremity muscle strength exercise of the non-paretic side using a mirror has a positive effect on muscle strength in patient with chronic stroke.

The effects of upper and lower limb position on symmetry of vertical ground reaction force during sit-to-stand in chronic stroke subjects.

[Purpose] The purpose of this study was to evaluate the influence of arm and leg posture elements on symmetrical weight bearing during Sit to Stand tasks in chronic stroke patients. [Subjects and Methods] The subjects were diagnosed with stroke and 22 patients (15 males and 7 females) participated in this study. All participants performed Sit to Stand tasks on three foot postures and two arm postures. Two force plates were used to measure peak of vertical ground reaction force and symmetrical ratio to peak Fz. The data were analyzed using independent t-test and two-way repeated ANOVA. [Results] The results of this study are as follows: 1) Peak Fz placed more weight in non-paretic leg during Sit to Stand. 2) A symmetrical ratio to Peak Fz indicated significant difference between foot and arm posture, and had non-paretic limb supported on a step and paretic at ground level (STP) and grasped arm posture that lock fingers together with shoulder flexion by 90°(GA) (0.79 ± 0.09). [Conclusion] These results suggest that STP posture of the legs and GA posture of the arms should be able to increase the use of the paretic side during Sit to Stand behavior and induce normal Sit to Stand mechanism through the anterior tilt of the hip in clinical practices, by which loads onto the knee joint and the ankle joint can be reduced, and the trunk righting response can be promoted by making the back fully stretched. The outcome of this study is expected to be a reference for exercise or prognosis of Sit to Stand in stroke patients.

Dynamic structure of lower limb joint angles during walking post-stroke

BackgroundVariability in joint kinematics is necessary for adaptability and response to everyday perturbations; however, intrinsic neuromotor changes secondary to stroke often cause abnormal movement patterns. How these abnormal movement patterns relate to joint kinematic variability and its influence on post-stroke walking impairments is not well understood. ObjectiveThe purpose of this study was to evaluate the movement variability at the individual joint level in the paretic and non-paretic limbs of individuals post-stroke. MethodsSeven individuals with hemiparesis post-stroke walked on a treadmill for two minutes at their self-selected speed and the average speed of the six-minute walk test while kinematics were recorded using motion-capture. Variability in hip, knee, and ankle flexion/extension angles during walking were quantified with the Lyapunov exponent (LyE). Interlimb differences were evaluated. ResultsThe paretic side LyE was higher than the non-paretic side at both self-selected speed (Hip: 50%; Knee: 74%), and the average speed of the 6-min walk test (Hip: 15%; Knee: 93%). ConclusionDifferences in joint kinematic variability between limbs of persons post-stroke supports further study of the source of non-paretic limb deviations as well as the clinical implications of joint kinematic variability in persons post-stroke. The development of bilaterally-targeted post-stroke gait interventions to address variability in both limbs may promote improved outcomes.

Relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors: a cross-sectional study

ObjectiveTo examine the relationships between muscle mass, intramuscular adipose and fibrous tissues of the quadriceps, and gait independence in chronic stroke survivors. DesignCross-sectional study. SettingHospital-based research. ParticipantsSeventeen chronic stroke survivors who were unable to walk independently (non-independent walker group) and 11 chronic stroke survivors who were able to walk independently (independent walker group) participated in this study. In addition, 25 healthy older adults (healthy group) were enrolled. InterventionsNone. Main outcome measuresThe muscle mass and intramuscular adipose and fibrous tissues of the rectus femoris and vastus intermedius were assessed based on muscle thickness and echo intensity of ultrasound images, respectively. ResultsThe thicknesses of the rectus femoris and vastus intermedius on the paretic and non-paretic sides in the non-independent walker group were significantly lower than those in the healthy group (mean difference −0.5 to −0.2cm; P<0.001–0.037). The paretic side in the non-independent walker group had significantly higher rectus femoris and vastus intermedius echo intensity compared with the healthy group (mean difference 15.8–17.4; P=0.007–0.025). The thickness of the rectus femoris on the non-paretic side was significantly lower in the independent walker group than in the healthy group (mean difference −0.3cm; P=0.001). ConclusionsThese results suggest that chronic stroke survivors who are unable to walk independently are likely to experience secondary changes in skeletal muscle on both the paretic and non-paretic sides.