People Post Stroke Research Articles

Physical activity and influencing factors in people post stroke or transient ischemic attack across diverse regions in Sweden

Background and purposePhysical activity (PA) and sedentary behavior are key targets for secondary stroke prevention, yet their characteristics and contributing factors are not well understood. This study aims to explore PA and sedentary behavior in individuals' post-stroke or transient ischemic attack (TIA) and identify factors linked to low PA (≤5,000 steps/day) and prolonged sedentary time (≥8 h/day).MethodsA cross-sectional study comparing sensor-derived (activPAL) PA and sedentary time among community-dwelling individuals post stroke or TIA residing in diverse geographical regions of Sweden. Multiple logistic regression models were performed to determine potential factors associated with low PA and prolonged sedentary time.ResultsThe study included 101 participants post-stroke (n = 68) and TIA (n = 33), with a mean age of 70.5 years (65% female), mostly with no or mild disability (91%), living in metropolitan (69%) and rural (31%) areas of Sweden. Most participants (72%) had ≥ 8 h of sedentary time per day and 38% performed ≤5,000 steps per day. Using a walking aid (OR = 11.43, p = 0.002) was independently associated with low PA, whereas contextual factors; living alone (OR = 3.49, p = 0.029) and living in metropolitan areas (OR = 2.79, p = 0.036), were associated with prolonged sedentary time.Discussion and conclusionsIn this study encompassing people post stroke or TIA from diverse geographical regions across Sweden, PA was associated with mobility status whereas sedentary behavior was associated with contextual factors. The results also showed a large variation in PA highlighting the need for tailored strategies to promote PA post stroke or TIA.

New technology to address affected vs nonaffected arm contributions to ergometer performance in people poststroke

ABSTRACT Background When pedaling a coupled-crank arm ergometer, individuals with hemiplegia may experience nonparetic arm overcompensation, and paretic arm resistance, due to neuromechanical deficits. Technologies that foster independent limb contributions may increase the effectiveness of exercise for people poststroke. Objective Examine the speed during uncoupled pedaling with the Advanced Virtual Exercise Environment Device among individuals poststroke and non-impaired comparisons. Methods We recruited 2 groups:Poststroke and Comparison. Participants attended one lab session and performed peak speed tests and a graded exercise repeated for bilateral pedaling, unilateral (left, right). Results Thirty-one participants completed the protocol (16 women, 15 men). Poststroke participants pedaled slower during the bilateral speed test (64 ± 39 RPM, p < .001), and graded exercise, (54 ± 28 RPM, p < .001) versus comparisons (141 ± 19, 104 ± 12 RPM). Poststroke individuals had lower peak RPM during the unilateral speed test with their paretic arm (70 ± 46 RPM, p < .001) and graded exercise (58 ± 33 RPM, p < .001) compared to their unilateral speed test (130 ± 37 RPM) and graded exercise (108 ± 25 RPM) with their nonparetic arm. Comparisons did not differ between arms during speed tests and graded exercise. Poststroke participants demonstrated lower peak speed with their affected arm during the bilateral speed test (52 ± 42 RPM, p < .001) and graded exercise (49 ± 28 RPM, p = .008) compared to the same arm during unilateral speed (70 ± 46 RPM) and graded exercise (58 ± 33 RPM). Conclusions Poststroke participants pedaled faster with their affected arm unilaterally versus bilateral pedaling, suggesting interhemispheric interference that reduces the ability to recruit the paretic arm during bilateral exercise.

An Algorithm for Activity Recognition and Assessment of Adults Poststroke.

Stroke is the leading cause of long-term disability in the United States. Providers have no robust tools to objectively and accurately measure the activity of people with stroke living at home. To explore the integration of validated upper extremity assessments poststroke within an activity recognition system. Exploratory descriptive study using data previously collected over 3 mo to report on algorithm testing and assessment integration. Data were collected in the homes of community-dwelling participants. Participants were at least 6 mo poststroke, were able to ambulate with or without an assistive device, and self-reported some difficulty using their arm in everyday activities. The activity detection algorithm's accuracy was determined by comparing its activity labels with manual labels. The algorithm integrated assessment by describing the quality of upper extremity movement, which was determined by reporting extent of reach, mean and maximum speed during movement, and smoothness of movement. Sixteen participants (9 women, 7 men) took part in this study, with an average age of 63.38 yr (SD = 12.84). The algorithm was highly accurate in correctly identifying activities, with 87% to 95% accuracy depending on the movement. The algorithm was also able to detect the quality of movement for upper extremity movements. The algorithm was able to accurately identify in-kitchen activities performed by adults poststroke. Information about the quality of these movements was also successfully calculated. This algorithm has the potential to supplement clinical assessments in treatment planning and outcomes reporting. Plain-Language Summary: This study shows that clinical algorithms have the potential to inform occupational therapy practice by providing clinically relevant data about the in-home activities of adults poststroke. The algorithm accurately identified activities that were performed in the kitchen by adults poststroke. The algorithm also identified the quality of upper extremity movements of people poststroke who were living at home.

Aplicarea unui program de terapii cognitive a depresiei persoanelor cu accident vascular cerebral

This article describes the effectiveness of the application of a program of cognitive therapies for the depression of people with stroke, from the moment of initial contact with the psychologist during the acute period, as well as at the following stages of rehabilitation, for the formation of affective-behavioral regulation skills. The intervention through this program contributed to the optimization of the psychosocial rehabilitation process, by capitalizing on some principles, directions, methods, techniques of an integrated approach to post-stroke people from different well-organized psychological orientations and beneficial development for this group of people.

Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study.

A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors. The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability. The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data. As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025. We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This "taking charge" approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke. DERR1-10.2196/52489.

Robotically driven Error Augmentation training enhances post‐stroke arm motor recovery

AbstractStroke is a major cause of long‐term functional disability and requires physical rehabilitation. Due to population aging, the number of people post stroke is going to rise. Robotically neurorehabilitation has a great potential to improve outcome measurements. Error Augmentation training using a robotic interface is thought to promote motor recovery by enhancing proprioceptive feedback, which motivates and challenges patients to optimize their performance during training. Here, we investigated the effectiveness of robotic Error Augmentation training on motor recovery after a stroke, compared to standard robotic training in a null field. Post‐stroke patients were randomly assigned to one of two groups: a study group (n = 9) that was trained on a 3D robotic system applying Error Augmentation forces, and a control group (n = 7) that carried out the same protocol in null field conditions. The robotic rehabilitation intervention was applied in addition to the standard rehabilitation protocol of the rehabilitation center. Error Augmentation training increased clinical scores compared to standard robotic training by 266% on the Motor Assessment Scale, and 88% on the Fugl‐Meyer scale. The Motor Assessment Scale scores were significantly correlated with the Fugl‐Meyer scores (p = 0.03, r = 0.541). There were more movement errors on the initial trials of the game sequence using the DeXtreme robotic device with Error Augmentation compared to trials with no force field. This difference vanished however after 10 trials. Error Augmentation training decreased the number of movement units and jerkiness compared to the control treatment. There was a robust effect of magnifying the acceleration component of movement using EA on the smoothness of the movement. These findings suggest that EA training may enhance motor performance possibly through motor adaptation. Future study should include EMG to better elucidate the neural mechanisms involved in motor learning post CNS injury.

Psychometric properties of portable devices used in kinematic gait assessment after stroke: a systematic review protocol

Background: Kinematic gait assessment is essential to the gait rehabilitation program after stroke. Portable devices composed of inertial sensors are an alternative for this evaluation. However, knowledge regarding the psychometric properties of these devices is needed to understand their accuracy, especially in evaluation of individuals with movement disorders (e.g., people post stroke). This systematic review aims to analyze the psychometric properties of portable devices that use inertial sensors to assess kinematic gait parameters in people post stroke. We will also investigate which portable device assesses alterations in lower limb angular movements during gait. Methods: We will search for studies in English without publication date restriction, that evaluated psychometric properties of portable devices that use inertial sensors to assess kinematic gait parameters in people after stroke. Searches will be performed in the following electronic databases: Cochrane Central Registry of Controlled Trials (CENTRAL), Medline/PubMed, EMBASE Ovid, CINAHL EBSCO, PsycINFO Ovid, IEEE Xplore Digital Library (IEEE), and Physiotherapy Evidence Database (PEDro). Gray literature will also be searched, including published and unpublished studies (dissertations and theses). The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) risk of bias tool will be used to assess the quality of studies that analyzed reliability and measurement error of devices. Expected results: This will be the first review assessing the risk of bias in studies that analyzed psychometric properties of portable devices that use inertial sensors to assess kinematic gait parameters in people post stroke. Then, we hope to elucidate this topic and help the decision-making of clinicians regarding the feasibility of these devices. Finally, we also hope to provide an overview of the characteristics of portable devices that assessed changes in angular lower limb movements during gait in this population. Registration: The protocol was registered in Open Science Framework on May 11th 2023 (https://doi.org/10.17605/OSF.IO/7M6DA).

Gait Training with Functional Electrical Stimulation Improves Mobility in People Post-Stroke

(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.

Mobile health to promote physical activity in people post stroke or transient ischemic attack – study protocol for a feasibility randomised controlled trial

BackgroundPhysical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND– Let’s get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden.MethodsOne hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments.DiscussionWe hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA.Trial registrationClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Effectiveness Test of Stroke Risk Detection Application Model, Stroke Risk Scorecard

Stroke is a disease caused by impaired blood circulation to the brain. This disease is a non-communicable disease that can be prevented by controlling stroke risk factors. STRIC (Stroke Risk Score Card) is a stroke risk detection application resulting from the development of a stroke risk detection model by the National Stroke Association. This study aims to determine the sensitivity, specificity, and accuracy of the application of the early stroke risk detection model (STRIC) in detecting stroke risk. Descriptive analytics by conducting stroke risk assessment using the Stroke Risk Scorecard (STRIC) App. The total sample was 60 people, consisting of 30 post-stroke people and 30 non-stroke people. The sensitivity value of the STRIC application is 91.67% which means that the ability to predict stroke risk for those who have experienced a stroke is very high. The specificity value of the STRIC application was 77.78%; this means that the measurement capability of the STRIC application provides a non-stroke (negative) result of 77.78% or very good. The accuracy value of the STRIC application is 83.33%, which means that the ability of the STRIC application to detect the risk of stroke in all subjects tested correctly is 83.33%. Applying the STRIC application can help prevent stroke and improve the prognosis for high-risk individuals.

Medicare Advantage Patterns of Poststroke Discharge to an Inpatient Rehabilitation or Skilled Nursing Facility: A Consideration of Demographic, Functional, and Payer Factors.

The purpose of this study was to determine the factors influencing the discharge to an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF) of people poststroke with Medicare Advantage plans. A retrospective cohort study was conducted with data from naviHealth, a company that manages postacute care discharge placement on behalf of Medicare Advantage organizations. The dependent variable was discharge destination (IRF or SNF). Variables included age, sex, prior living setting, functional status (Activity Measure for Post-Acute Care [AM-PAC]), acute hospital length of stay, comorbidities, and payers (health plans). Analysis estimated relative risk (RR) of discharge to SNF, while controlling for regional variation. Individuals discharged to an SNF were older (RR = 1.17), women (RR = 1.05), lived at home alone or in assisted living (RR = 1.13 and 1.39, respectively), had comorbidities impacting their function "some" or "severely" (RR = 1.43 and 1.81, respectively), and had a length of stay greater than 5days (RR = 1.16). Individuals with better AM-PAC Basic Mobility (RR = 0.95) went to an IRF, and individuals with better Daily Activity (RR = 1.01) scores went to an SNF. There was a substantial, significant variation in discharge of individuals to SNF by payer group (RR range = 1.12-1.92). The results of this study show that individuals poststroke are more likely to be discharged to an SNF than to an IRF. This study did not find a different discharge decision-making picture for those with Medicare Advantage plans than previously described for other insurance programs. Medicare Advantage payers have varied patterns in discharge placement to an IRF or SNF for patients poststroke.

Quality of communication and quality of life of people with aphasia and dysarthria after stroke

Introduction. Aphasia and dysarthria are permanent consequences of stroke in many patients. These disorders significantly disrupt the person?s functioning in everyday life. The aim of this paper is to examine the quality of communication and quality of life in patients with aphasia and dysarthria. Material and Methods. The clinical group included 25 patients with aphasia and 20 patients with dysarthria due to stroke. The control group included 15 post-stroke people without speech and language disorders and 15 neurologically healthy subjects. The Quality of Communication Life Scale was used to assess the quality of communication. This scale provides information about the impact of speech and language disorders on individuals? ability to communicate and quality of life in general. The scale consists of 18 items scored from 1 to 5. Results. Patients with aphasia and dysarthria have a significantly lower quality of communication compared to stroke survivors with preserved speech and language functions and neurologically healthy subjects. The severity of the language and speech disorder proved to be a significant factor in determining the quality of communication. Namely, patients with more severe forms of aphasia and dysarthria scored significantly lower on the Quality of Communication Life Scale compared to the patients with milder forms. It was also shown that patients with flaccid dysarthria have the worst quality of communication compared to the patients with other types of dysarthria. Conclusion. Aphasia and dysarthria following a stroke significantly impair the quality of communication and quality of life of the affected persons.

Case Management for People with Stroke: Quasi experimental study

Objective: to compare the effect of intervention by nurse-case manager on risk factors and blood pressure in post-stroke people. Method: quasi-experimental study conducted over six months with 14 post-stroke patients in southern Brazil. The intervention with case management consisted of nursing consultations, individualized educational actions and referrals to other professionals, operationalized in three home visits and six telephone contacts. For data analysis, descriptive statistics and Fisher’s test were used, with a significance level of p≤0.05. Results: Reduction of smoking (p=0.0414), alcohol intake (p=0), sodium consumption (p=0.0024), fat (p=0.0027), carbohydrate (p=0.0203) and sugar (p=0.0111), increased physical activity (p=0.0382) and non-significant reduction of blood pressure levels were observed. Conclusion: Nurse-led case management is a valid strategy to follow people recovering from stroke.

A Comparative Study to Check the Effectiveness of Task Oriented Activity on Walking Speed in Sub-Acute Stroke Patients

Stroke which is also known as cerebrovascular accident (CVA) is a leading cause of impairment and disability in the world. There are many factors that affect the functional independence in post stroke people in which gait impairment plays a significant role. The purpose of stroke rehabilitation is to help patients to achieve as high level of functional independence as possible within their particular impairments. It is found that Task oriented activity has been shown to be an effective intervention to improve mobility. However, little is known about the impact of this intervention on the walking speed. The objective of study is to determine the combined effects of task oriented activity with conventional physiotherapy over conventional physiotherapy alone on walking speed in subjects with sub-acute stroke. This was a comparative study where pre and post design were used. Thirty (30) subjects with sub-acute stroke were taken considering the selection criteria; where Experimental group (Group-A) received task oriented activities and conventional physiotherapy and Control group (Group-B) received Conventional physiotherapy with 15 subjects in each group. Six minutes walk test (MWT) was used to assess the walking endurance and Functional ambulation categories (FAC) was used to evaluate the level of dependency of subjects in performing functional activities. Statistical analysis was done by using paired ‘t’ tests which showed significant improvement as the mean value of Group A (experimental group) mean 6MWT increase from -0.517 to -17.582, mean FAC increase from -1.288 to -3.055 but when intergroup analysis was done, its result was significant only in 6MWT were P= 0.046. task oriented activity after stroke could significantly improve walking endurance but not much significant on the level of dependency of the subject in performing functional activities.

Establishing Accelerometer Cut-Points to Classify Walking Speed in People Post Stroke.

While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waist- and ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41–0.8 m/s, 0.81–1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively. Across all speed categories, cut-point classification accuracy was good-to-excellent for the ankle-worn AG accelerometer and fair-to-excellent for the waist-worn AG accelerometer, except for between 0.81 and 1.2 m/s. These cut-points can be used for investigating the link between walking and health outcomes in people post stroke.

EMG-driven fatigue-based self-adapting admittance control of a hand rehabilitation robot

Upper-limb rehabilitation therapy sessions for post-stroke people generally contain rhythmic hand movements in a tiresome manner to rebuild the injured neural circuits. Fatigue formation causes breaks in the training and limits the therapy duration. Therefore, it is essential to establish a correlation between the patient’s muscle condition and the rehabilitation exercises to improve the physiotherapy sessions. A self-adapting control method based on online fatigue detection in rhythmic arm movements is presented. Experimental tests were performed on twenty healthy subjects to validate the method’s feasibility. Electromyography (EMG) and force signals considered the interfaces between users and the robot. In the first stage of the experiment, utilizing the frequency features from EMG signals, a neural network for fatigue detection trained; however, in the end, it substituted with a simple function as a refinement in the time-consuming aspect for the online employment. The initiation of the fatigue process is followed by reducing the admittance controller damping term based on the EMG signal processing. Trajectory tracking with the robot employs the self-adapting admittance controller (SAAC) method and the non-adapting admittance controller (NAAC). Movement accuracy and smoothness were measured and showed a better performance of the SAAC method related to the NAAC. Simulations with two different stiffness levels were performed on an upper-limb OpenSim model to study a stroke-injured arm and evaluate the proposed method’s proficiency. The metabolic cost indicated the movement’s superiority in a fatigue situation for reduced environment stiffness.

Photobiomodulation Therapy Combined with Static Magnetic Field (PBMT-SMF) on Spatiotemporal and Kinematics Gait Parameters in Post-Stroke: A Pilot Study.

Background: Gait deficit is a major complaint in patients after stroke, restricting certain activities of daily living. Photobiomodulation therapy combined with a static magnetic field (PBMT-SMF) has been studied for several diseases, and the two therapies are beneficia. However, their combination has not yet been evaluated in stroke. Therefore, for PBMT–SMF to be used more often and become an adjunctive tool in the rehabilitation of stroke survivors at physical therapy rehabilitation centers and clinics, some important aspects need to be clarified. Purpose: This study aimed to test different doses of PBMT–SMF, to identify the ideal dose to cause immediate effects on the spatiotemporal and kinematic variables of gait in post-stroke patients. Methods: A randomized, triple-blinded, placebo-controlled crossover pilot study was performed. A total of 10 individuals with hemiparesis within 6 months to 5 years since the occurrence of stroke, aged 45–60 years, were included in the study. Participants were randomly assigned and treated with a single PBMT–SMF dose (sham, 10 J, 30 J, or 50 J) on a single application, with one dose per stage at 7-day intervals between stages. PBMT–SMF was applied with a cluster of 12 diodes (4 of 905 nm laser, 4 of 875 nm LEDs, and 4 of 640 nm LEDs, SMF of 35 mT) at 17 sites on both lower limbs after baseline evaluation: plantar flexors (2), knee extensors (9), and flexors (6). The primary outcome was self-selected walking speed, and the secondary outcomes were kinematic parameters. Gait analysis was performed using SMART-D 140® and SMART-D INTEGRATED WORKSTATION®. The outcomes were measured at the end of each stage after the single application of each PBMT–SMF dose tested. Results: No significant differences (p > 0.05) in spatiotemporal variables were observed between the different doses, compared with the baseline evaluation. However, differences (p < 0.05) were observed in the kinematic variable of the hip in the paretic and non-paretic limbs, specifically in the minimum flexion/extension angulation during the support phase (HMST–MIN) in doses 10 J, 30 J, and 50 J. Conclusions: A single application of PBMT–SMF at doses of 10 J, 30 J, and 50 J per site of the lower limbs did not demonstrate positive effects on the spatiotemporal variables, but it promoted immediate effects in the kinematic variables of the hip (maximum and minimum flexion/extension angulation during the support phase) in the paretic and non-paretic limbs in post-stroke people.

Postural Maintenance Is Associated With Walking Ability in People Receiving Acute Rehabilitation After a Stroke.

The Postural Assessment Scale for Stroke Patients (PASS) assesses the ability of people post stroke to maintain or change a given posture from lying to standing, and the items on which people with different walking status perform differently may suggest potential interventions. The purpose of this study was to (1) examine the association of PASS scores at admission for acute rehabilitation with walking status at admission and 3months post stroke (3 M), and (2) identify PASS items that discriminate walking status. In this prospective observational study, 93 people post stroke were assessed with the PASS and a 2.44-m gait speed test at admission, with walking status assessed by telephone interview at 3 M. Those who could walk over a 2.44-m distance without the assistance of a walking aid or another person were considered to be independent in walking; others were considered to be dependent. Those who were dependent at admission were divided into the "regained independence" and "remained dependent" groups based on their status at 3 M. The association of the PASS at admission with 3 levels of walking status (independent at admission, regained independence, and remained dependent) was examined using the Kruskal-Wallis test. For those dependent at admission, the association of PASS score at admission with walking status at 3 M was examined using logistic regression and receiver operating curve analysis. PASS scores at admission differed significantly across the 3 walking status groups and were significantly associated with walking status at 3 M (odds ratio = 0.864; 95% CI = 0.798-0.935) over and above length of stay. People post stroke who were dependent at admission and had PASS scores ≥22 were more likely to regain independence at 3 M. Nine PASS items differed among the 3 groups. PASS score is significantly associated with walking status at admission and at 3 M. The identified 9 items suggest possible interventions for acute rehabilitation. This study identified 9 PASS items that could guide clinicians in selecting interventions for acute rehabilitation.

The acute effects of aerobic exercise on sensorimotor adaptation in chronic stroke.

Background:Sensorimotor adaptation, or the capacity to adapt movement to changes in the moving body or environment, is a form of motor learning that is important for functional independence (e.g., regaining stability after slips or trips). Aerobic exercise can acutely improve many forms of motor learning in healthy adults. It is not known, however, whether acute aerobic exercise has similar positive effects on sensorimotor adaptation in stroke survivors as it does in healthy individuals.Objective:The aim of this study was to determine whether acute aerobic exercise promotes sensorimotor adaptation in people post stroke.Methods:A single-blinded crossover study. Participants attended two separate sessions, completing an aerobic exercise intervention in one session and a resting control condition in the other session. Sensorimotor adaptation was assessed before and after each session, as was brain derived neurotrophic factor. Twenty participants with chronic stroke completed treadmill exercise at moderate to high intensity for 30 minutes.Results:Acute aerobic exercise in chronic stroke survivors significantly increased sensorimotor adaptation from pre to post treadmill intervention. The 30-minute treadmill intervention resulted in an averaged 2.99 ng/ml increase in BDNF levels (BDNF pre-treadmill = 22.31 + /–2.85 ng/ml, post-treadmill was = 25.31 + /–2.46 pg/ml; t(16) = 2.146, p = 0.048, cohen’s d = 0.521, moderate effect size).Conclusions:These results indicate a potential role for aerobic exercise to promote the recovery of sensorimotor function in chronic stroke survivors.

Efficacy of a Forearm Rotation Orthosis for People With a Hemiparetic Arm.

Insufficient voluntary forearm movements are associated with ineffective and inefficient functional performance among people poststroke. Although evidence supports the application of the occupational therapy task-oriented (OTTO) approach for this population, the training protocol does not explicitly address the role of forearm rotation movements. In addition, a need exists for theoretical support for orthotic interventions for people poststroke. Objective: To examine the efficacy of (1) a forearm rotation orthosis, (2) the OTTO approach, and (3) the combination of the two with people poststroke with a hemiparetic arm. Stratified, randomized, two-group, single-blinded, repeated-measures design. Rehabilitation clinic. Participants (N = 14) with a diagnosis of stroke and at least 10° of voluntary shoulder and elbow movement. Participants were stratified into three groups by motor function (mild, moderate, severe) and randomly assigned either to 6 wk of no treatment followed by 6 wk of OTTO or to 6 wk of orthotic intervention followed by 6 wk of orthosis plus OTTO. Outcomes and Measures: Primary outcome measures were the Canadian Occupational Performance Measure (COPM), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL), administered at baseline (Week 1), at the end of Phase 1 (Week 7), and at the end of Phase 2 (Week 15) by blinded evaluators. Both groups showed clinically important improvements on the COPM. No significant differences were found on the WMFT or MAL. The OTTO intervention provides clinically important benefits in self-perceived functional performance to people poststroke. What This Article Adds: The OTTO approach is an occupation-focused intervention that aims at functional performance and emphasizes clients' active engagement throughout the process. The findings suggest that the protocol of the OTTO intervention and its efficacy are appropriate for clinical practice.