Post-stroke Participants Research Articles

The Kinematics of 3D Arm Movements in Sub-Acute Stroke: Impaired Inter-Joint Coordination is Attributable to Both Weakness and Flexor Synergy Intrusion

Background It has long been of interest to characterize the components of the motor abnormality in the arm after stroke. One approach has been to decompose the hemiparesis phenotype into negative signs, such as weakness, and positive signs, such as intrusion of synergies. We sought to identify the contributions of weakness and flexor synergy to motor deficits in sub-acute stroke. Methods Thirty-three sub-acute post-stroke participants and 16 healthy controls performed two functional arm movements; one within flexor synergy (shoulder and elbow flexion), and the other outside flexor synergy (shoulder flexion and elbow extension). We analyzed upper limb 3D kinematics to assess both overall task performance and intrusion of pathological synergies. Weakness and spasticity were also measured. Results Both tasks produced similar impairments compared to controls. Analysis of elbow and shoulder multi-joint coordination patterns revealed intrusion of synergies in the out-of-synergy reaching task based on the time spent within a flexion-flexion pattern and the correlation between shoulder and elbow angles. Regression analysis indicated that both weakness and synergy intrusion contributed to motor impairment in the out-of-synergy reaching task. Notably, the Fugl-Meyer Assessment (FMA) was abnormal even when only weakness caused the impairment, cautioning that it is not a pure synergy scale. Conclusions Weakness and synergy intrusion contribute to motor deficits in the sub-acute post-stroke period. An abnormal FMA score cannot be assumed to be due to synergy intrusion. Careful kinematic analysis of naturalistic movements is required to better characterize the contribution of negative and positive signs to upper limb impairment after stroke.

Feasibility of a neurorehabilitation pipeline and an automated algorithm to select appropriate treatments for upper extremity motor paralysis in individuals with chronic stroke.

This study aimed to investigate the feasibility of a neurorehabilitation pipeline and develop an algorithm to automatically select the appropriate treatment for individuals with upper extremity motor paralysis after stroke in the chronic phase. In Experiment 1, eight post-stroke participants in the chronic phase who underwent treatment sustaining two to three phases were assessed before and after treatment. In Experiment 2, a decision tree analysis was performed in which the dependent variable was set as the treatment option determined by a board-certified physiatrist for 95 post-stroke participants; the independent variables were only motor function scores or both motor function scores and electromyogram variables. In Experiment 1, the clinical assessment scores were improved significantly after treatment. Experiment 2 showed that the agreements of the model with only motor function scores as the dependent variable and with motor function scores and electromyogram variables as the dependent variables were 75.8% and 82.1%, respectively. This novel treatment package is feasible for improvement of motor function in post-stroke individuals with severe motor paralysis. The study also established an automated algorithm for selecting appropriate treatments for upper extremity motor paralysis after stroke, identifying standard values of key variables, including electromyography variables.

Validity and reliability of the chronic composite XA, an upper limb motor assessment using Active Range of Motion in patients with chronic stroke.

Upper limb (UL) spastic paresis has been classically evaluated with assessments of passive movements with limited functional validity. The aim of this study was to assess whether a composite measure of active range of motion (AROM, or X<inf>A</inf>) is valid and reliable in chronic post-stroke spastic paresis. The primary objective was to investigate the validity and reliability of a composite score, comprising multiple X<inf>A</inf> measurements, to assess UL spastic paresis in patients in chronic stages post-stroke. In addition to this, an exploratory analysis was conducted to identify which muscles should be optimally included in this composite score. A psychometric proprieties study. Physical and Rehabilitation Medicine Department. twenty-eight chronic post-stroke participants with spastic paresis. Composite UL X<inf>A</inf> measurement in twenty-eight chronic post-stroke participants (age=59±11 years; delay post-stroke=29±37 months) with spastic paresis was repeated twice about 40 days apart in a standardized body position. Concurrent and construct validity was evaluated exploring correlation with the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and grip strength (JAMAR™). Reliability was assessed by calculating intraclass correlation coefficients (ICC). Regarding the exploratory analysis, a linear regression analysis was performed to examine the value of including various muscles. Composite X<inf>A</inf> against the resistance of elbow, wrist and finger flexors showed strong correlation with FMA-UE and ARAT (r=0.88; P<0.001 and r=0.82; P<0.001 respectively) and a weak association with grip strength (r=0.43; P=0.03). Test-retest reliability was excellent (ICC=0.92). However, the most effective regression model also included X<inf>A</inf> against the resistance of shoulder adductors as well as forearm pronator (adjusted R2=0.85; AIC=170). The present study provided satisfactory psychometric data for the upper limb composite active movement (CX<inf>A</inf>), derived from the Five Step Assessment. For overall measurement of UL mobility after stroke, we strongly recommend including shoulder and forearm muscles to the score. Composite X<inf>A</inf> is a valid and reliable measure of upper limb motor function in chronic post-stroke patients and could be used in clinical practice and research.

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.

Effects of ankle–foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

BackgroundAnkle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO.MethodsTwenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed.ResultsAll 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05).ConclusionsPost-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Constraint-induced movement therapy through telerehabilitation for upper extremity function in stroke

BackgroundStroke is considered to be a leading cause of impairment. After experiencing strokes, patients are frequently left with impaired motor function, making it difficult to carry out daily tasks. The most extensively researched method for treating stroke patients in recent decades is CIMT (constraint-induced movement therapy), which was developed to treat upper limb deficits following stroke. CIMT entails limiting the use of the unaffected limb, altering behavior to increase the use of the affected limb, and finally, mass-training of the affected limb. ObjectiveThe current study aimed to determine the effectiveness of CIMT through TR for upper extremity function in stroke patients. Materials and methodsThirty post-stroke participants were selected on the basis of inclusion and exclusion criteria, and allocated into group A and group B. Group A was treated with CIMT in the physiotherapy department and group B was treated with CIMT through TR. Outcome measures were the Fugl-Meyer Assessment scale for upper extremities (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). ResultsBoth groups showed significant improvements in FMA-UE, WMFT and MAL-A0U, MAL-Q0M scores. However, there were no significant differences between groups A and B in FMA-UE, WMFT, MAL-AOU, and MAL-QOM scores in the inter-group analysis. ConclusionCIMT via TR was equally effective than CIMT in physiotherapy department for upper extremity function in stroke. Further studies should be conducted to identify the long-term effectiveness of this approach.

Multi-Site Identification and Generalization of Clusters of Walking Behaviors in Individuals With Chronic Stroke and Neurotypical Controls

Background Walking patterns in stroke survivors are highly heterogeneous, which poses a challenge in systematizing treatment prescriptions for walking rehabilitation interventions. Objectives We used bilateral spatiotemporal and force data during walking to create a multi-site research sample to: (1) identify clusters of walking behaviors in people post-stroke and neurotypical controls and (2) determine the generalizability of these walking clusters across different research sites. We hypothesized that participants post-stroke will have different walking impairments resulting in different clusters of walking behaviors, which are also different from control participants. Methods We gathered data from 81 post-stroke participants across 4 research sites and collected data from 31 control participants. Using sparse K-means clustering, we identified walking clusters based on 17 spatiotemporal and force variables. We analyzed the biomechanical features within each cluster to characterize cluster-specific walking behaviors. We also assessed the generalizability of the clusters using a leave-one-out approach. Results We identified 4 stroke clusters: a fast and asymmetric cluster, a moderate speed and asymmetric cluster, a slow cluster with frontal plane force asymmetries, and a slow and symmetric cluster. We also identified a moderate speed and symmetric gait cluster composed of controls and participants post-stroke. The moderate speed and asymmetric stroke cluster did not generalize across sites. Conclusions Although post-stroke walking patterns are heterogenous, these patterns can be systematically classified into distinct clusters based on spatiotemporal and force data. Future interventions could target the key features that characterize each cluster to increase the efficacy of interventions to improve mobility in people post-stroke.

Interlimb Coordination during Double Support Phase of Gait in People with and without Stroke

This study aims to identify differences between participants with and without stroke regarding the ipsilesional and contralesional lower limbs kinematics, kinetics, muscle activity and their variability during double support phase of gait. Eleven post-stroke and thirteen healthy participants performed 10 gait trials at a self-selected speed while being monitored by an optoelectronic motion capture system, two force plates and an electromyographic system. The following outcomes were evaluated during the double support: the time and the joint position; the external mechanical work on the centre of mass; and the relative electromyographic activity. Both, contralesional/ipsilesional and dominant/non-dominant of participants with and without stroke, respectively, were evaluated during double support phase of gait in trailing or leading positions. The average value of each parameter and the coefficient of variation of the 10 trials were analysed. Post-stroke participants present bilateral decreased mechanical work on the centre of mass and increased variability, decreased contralesional knee and ankle flexion in trailing position, increased ipsilesional knee flexion in leading position and increased variability. Increased relative muscle activity was observed in post-stroke participants with decreased variability. Mechanical work on the centre of mass seems to be the most relevant parameter to identify interlimb coordination impairments in post-stroke subjects.

Development and Testing of a Daily Activity Recognition System for Post-Stroke Rehabilitation.

Those who survive the initial incidence of a stroke experience impacts on daily function. As a part of the rehabilitation process, it is essential for clinicians to monitor patients' health status and recovery progress accurately and consistently; however, little is known about how patients function in their own homes. Therefore, the goal of this study was to develop, train, and test an algorithm within an ambient, in-home depth sensor system that can classify and quantify home activities of individuals post-stroke. We developed the Daily Activity Recognition and Assessment System (DARAS). A daily action logger was implemented with a Foresite Healthcare depth sensor. Daily activity data were collected from seventeen post-stroke participants' homes over three months. Given the extensive amount of data, only a portion of the participants' data was used for this specific analysis. An ensemble network for activity recognition and temporal localization was developed to detect and segment the clinically relevant actions from the recorded data. The ensemble network, which learns rich spatial-temporal features from both depth and skeletal joint data, fuses the prediction outputs from a customized 3D convolutional-de-convolutional network, customized region convolutional 3D network, and a proposed region hierarchical co-occurrence network. The per-frame precision and per-action precision were 0.819 and 0.838, respectively, on the test set. The outcomes from the DARAS can help clinicians to provide more personalized rehabilitation plans that benefit patients.

Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study.

Introduction: Tuning the control parameters is one of the main challenges in robotic gait therapy. Control strategies that vary the control parameters based on the user's performance are still scarce and do not exploit the potential of using spatiotemporal metrics. The goal of this study was to validate the feasibility of using shank-worn Inertial Measurement Units (IMUs) for clinical gait analysis after stroke and evaluate their preliminary applicability in designing an automatic and adaptive controller for a knee exoskeleton (ABLE-KS). Methods: First, we estimated the temporal (i.e., stride time, stance, and swing duration) and spatial (i.e., stride length, maximum vertical displacement, foot clearance, and circumduction) metrics in six post-stroke participants while walking on a treadmill and overground and compared these estimates with data from an optical motion tracking system. Next, we analyzed the relationships between the IMU-estimated metrics and an exoskeleton control parameter related to the peak knee flexion torque. Finally, we trained two machine learning algorithms, i.e., linear regression and neural network, to model the relationship between the exoskeleton torque and maximum vertical displacement, which was the metric that showed the strongest correlations with the data from the optical system [r = 0.84; ICC(A,1) = 0.73; ICC(C,1) = 0.81] and peak knee flexion torque (r = 0.957). Results: Offline validation of both neural network and linear regression models showed good predictions (R2 = 0.70-0.80; MAE = 0.48-0.58Nm) of the peak torque based on the maximum vertical displacement metric for the participants with better gait function, i.e., gait speed > 0.7m/s. For the participants with worse gait function, both models failed to provide good predictions (R2 = 0.00-0.19; MAE = 1.15-1.29Nm) of the peak torque despite having a moderate-to-strong correlation between the spatiotemporal metric and control parameter. Discussion: Our preliminary results indicate that the stride-by-stride estimations of shank-worn IMUs show potential to design automatic and adaptive exoskeleton control strategies for people with moderate impairments in gait function due to stroke.

Motor Imagery and Paired Associative Stimulation in Poststroke Rehabilitation: Dissociating Motor and Electrophysiological Effects

Paired associative stimulation (PAS) is an intervention that modulates cortical plasticity. Motor imagery (MI) is used in the rehabilitation of stroke patients. We aimed to evaluate the possible synergistic effect of associating both interventions for potentiating motor recovery poststroke. MIPAS is a single-center, randomized controlled trial that enrolled 24 hemiparetic poststroke participants. Three single-session interventions were tested in a crossover design: PAS/MI, PAS, and ShamPAS/MI during which the affected Extensor Carpi Radialis (ECR) muscle was targeted. During MI, the participants were instructed to imagine extending their paretic wrist. We used Sham, subthreshold stimulation during ShamPAS. Changes in ECR Motor-Evoked Potential (MEP) areas and paretic wrist Range of Motion (aROM) during active extension were compared between the interventions. We observed no significant superior effect of any intervention, neither on MEP nor on wrist aROM. A time of assessment effect was highlighted for both outcome measures, with MEP- and aROM-measured post-interventions significantly higher than those measured pre-intervention. Despite the beneficial effect of each intervention on participant paretic wrist motor function, not always associated with MEP change, our results do not highlight a specific advantage in combining PAS and MI interventions in post-stroke motor rehabilitation.

321 Paired associative stimulation: a tool for assessing sensorimotor neural signaling and lower limb function post-stroke

OBJECTIVES/GOALS: A stroke can impair neural communication between sensory and motor pathways thus compromising walking function. Paired associative stimulation (PAS) is a useful assay of sensorimotor integration (SMI) with limited use post-stroke. The objective of this study will be to determine lower extremity PAS effectiveness and reliability post-stroke. METHODS/STUDY POPULATION: This study will use a pre-post, cross-sectional design. Ten healthy controls and 10 individuals with chronic stroke (&gt;6 months) will be recruited. PAS protocols will be individualized to account for between-subject variability in sensorimotor signaling by first measuring cortical sensory signaling using electroencephalography. Post-stroke participants will then receive PAS targeting the paretic tibialis anterior muscle; healthy controls will receive PAS targeting the non-dominant TA. Changes in cortically derived muscle responses will be characterized by absolute motor-evoked potential amplitude (MEPAmp) change, elicited by transcranial magnetic stimulation, over two sessions separated by &gt;24 hours. Clinical measures of sensorimotor function and walking ability will also be performed. RESULTS/ANTICIPATED RESULTS: By individualizing PAS protocols, we expect to see significant increases in MEPAmp pre to post PAS, determined using paired t-tests. We also anticipate reliable PAS-induced increases in MEPAmp, which will be assessed using two reliability statistics: intraclass correlation coefficient and coefficients of variation of method error. Lastly, the increases in MEPAmp will be correlated with measures of sensorimotor function and walking ability, anticipating that greater increases in MEPAmp will be related to better walking ability and sensorimotor functioning. Correlations will be assessed via a Pearson’s correlation. A preset alpha = 0.05 will be used to determine significant findings. DISCUSSION/SIGNIFICANCE: The importance of this study is that establishing individualized PAS protocols could potentially provide a reliable and clinically relevant measure of SMI. Understanding post-stroke lower extremity SMI is necessary for furthering targeted and personalized interventions to combat walking deficits.

Effect of Dual Task Training, Gait Training and Vestibular Rehabilitation on Balance and Quality of Life in Post Stroke Adults

OBJECTIVE: To investigate the effectiveness of dual task training, gait training and vestibular rehabilitation on balance and quality of life in post stroke adults. MATERIALS AND METHODS: This Pilot study was carried out on 45 post stroke participants both male and female who fulfilled the inclusion criteria were recruited for the study with age group between 40 to 60 years from out-patient physiotherapy department of Dr. M.G.R. Educational and Research Institute, Deemed to beUniversity. The subjects were randomly assigned into 3 groups, each group consisting of 15 subjects. Group A received dual task training for thrice a week of 45 minutes per session for 4 weeks. Group B received gait training program for thrice a week of 30 minutes per session for 6 weeks. Group C received Cawthorne and Cooksey exercises of vestibular rehabilitation for thrice a week of 60 minutes per session for 8 weeks. The outcome measures used were Global Quality of Life Scale (GQOL) and Berg Balance Scale (BBS). RESULT: When the mean values of GroupA, Group B and Group C were compared on GQOL and BBS scale revealed significant increase in the post test mean value with Group C showing 87 and 55 on GQOL and BBS respectively, which was higher than Group A mean values 84.1, 52.33 and followed by Group B mean value 80, 53.3 at p ≤ 0.001. Hence, Group C which received vestibular rehabilitation was more effective than other groups.

Sensorimotor control of object manipulation following middle cerebral artery (MCA) stroke

Methods for assessing the loss of hand function post-stroke examine limited aspects of motor performance and are not sensitive to subtle changes that can cause deficits in everyday object manipulation tasks. Efficiently lifting an object entails a prediction of required forces based on intrinsic features of the object (sensorimotor integration), short-term updates in the forces required to lift objects that are poorly predicted (sensorimotor memory), as well as the ability to modulate distal fingertip forces, which are not measured by existing assessment tools used in clinics for both diagnostic and rehabilitative purposes. The presented research examined these three components of skilled object manipulation in 60 chronic, unilateral middle cerebral artery stroke participants. Performance was compared to age-matched control participants, and linear regressions were used to predict performance based on clinical scores. Most post-stroke participants performed below control levels in at least one of the tasks. Post-stroke participants presented with combinations of deficits in each of the tasks performed, regardless of the hemisphere damaged by the stroke. Surprisingly, the ability to modulate distal forces was impaired in those patients with damage ipsilateral (right hemisphere) to the hand being used. Sensorimotor integration was also impaired in patients with right hemisphere damage, though they performed at control levels in later lifts, whereas left-hemisphere-damaged patients did not. Lastly, during a task requiring sensorimotor memory, neither patient group performed outside of control ranges on initial lifts, with patients with right hemisphere damage showing impaired performance in later lifts suggesting they were unable to learn the mapping novel mapping of color and mass of the objects. The presented research demonstrates unilateral MCA stroke patients can have deficits in one or more components required for the successful manipulation of hand-held objects and that skillful object lifting requires intact bilateral systems. Further, this information may be used in future studies to aid efforts that target rehabilitation regimens to a stroke survivor's specific pattern of deficits.

Speed-dependent biomechanical changes vary across individual gait metrics post-stroke relative to neurotypical adults

BackgroundGait training at fast speeds is recommended to reduce walking activity limitations post-stroke. Fast walking may also reduce gait kinematic impairments post-stroke. However, it is unknown if differences in gait kinematics between people post-stroke and neurotypical adults decrease when walking at faster speeds.ObjectiveTo determine the effect of faster walking speeds on gait kinematics post-stroke relative to neurotypical adults walking at similar speeds.MethodsWe performed a secondary analysis with data from 28 people post-stroke and 50 neurotypical adults treadmill walking at multiple speeds. We evaluated the effects of speed and group on individual spatiotemporal and kinematic metrics and performed k-means clustering with all metrics at self-selected and fast speeds.ResultsPeople post-stroke decreased step length asymmetry and trailing limb angle impairment, reducing between-group differences at fast speeds. Speed-dependent changes in peak swing knee flexion, hip hiking, and temporal asymmetries exaggerated between-group differences. Our clustering analyses revealed two clusters. One represented neurotypical gait behavior, composed of neurotypical and post-stroke participants. The other characterized stroke gait behavior—comprised entirely of participants post-stroke with smaller lower extremity Fugl-Meyer scores than the post-stroke participants in the neurotypical gait behavior cluster. Cluster composition was largely consistent at both speeds, and the distance between clusters increased at fast speeds.ConclusionsThe biomechanical effect of fast walking post-stroke varied across individual gait metrics. For participants within the stroke gait behavior cluster, walking faster led to an overall gait pattern more different than neurotypical adults compared to the self-selected speed. This suggests that to potentiate the biomechanical benefits of walking at faster speeds and improve the overall gait pattern post-stroke, gait metrics with smaller speed-dependent changes may need to be specifically targeted within the context of fast walking.

Characterization of Functional Connectivity in Chronic Stroke Subjects after Augmented Reality Training

Augmented reality (AR) tools have been investigated with promising outcomes in rehabilitation. Recently, some studies have addressed the neuroplasticity effects induced by this type of therapy using functional connectivity obtained from resting-state functional magnetic resonance imaging (rs-fMRI). This work aims to perform an initial assessment of possible changes in brain functional connectivity associated with the use of NeuroR, an AR system for upper limb motor rehabilitation of poststroke participants. An experimental study with a case series is presented. Three chronic stroke participants with left hemiparesis were enrolled in the study. They received eight sessions with NeuroR to provide shoulder rehabilitation exercises. Measurements of range of motion (ROM) were obtained at the beginning and end of each session, and rs-fMRI data were acquired at baseline (pretest) and after the last training session (post-test). Functional connectivity analyses of the rs-fMRI data were performed using a seed placed at the noninjured motor cortex. ROM increased in two patients who presented spastic hemiparesis in the left upper limb, with a change in muscle tone, and stayed the same (at zero angles) in one of the patients, who had the highest degree of impairment, showing flaccid hemiplegia. All participants had higher mean connectivity values in the ipsilesional brain regions associated with motor function at post-test than at pretest. Our findings show the potential of the NeuroR system to promote neuroplasticity related to AR-based therapy for motor rehabilitation in stroke participants.

Functional Ability and Health Problems of Stroke Survivors: An Explorative Study.

Background A stroke is an emergency medical condition that needs to be treated promptly. Patients who suffer from stroke frequently experience varying degrees of impairment, necessitating emergency hospital treatment and prolonged home care. It can lower the quality of life which leads to social isolation and makes it harder to function independently. The purpose of this research was to assess thehealth issues and functional capacityof individuals living with stroke. Methodology An exploratory study was conducted in the neurological outpatient departmentof tertiary care hospitals in Chennai. A total of 30 post-stroke participants were selected using a convenient sampling technique. Data were collected by structured interviews using the Post-Stroke Checklist and Barthel Index. The data were analyzed through descriptive and inferential statistics. Results The majority of the patients were (86.7%) men in the age group of 55-65 years. Regarding the health problems identified with the Post-Stroke Checklist, the activities of daily living (80%) were the most common, and spasticity (48%) and pain (34%) were the least common. However, 60% of the participants had new problems related to vision, 66% had problems with hearing, 76% had problems with getting around inside or outside, and 60% had a history of a recent fall. Further, 52% had problems with remembering and concentrating on things, 72% had problems sleeping, and 45% were worried about their relationship with their spouse after the stroke. The median Barthel Index score was 43.5. Conclusions More than half of all stroke survivors were dependent on others for everyday activities. We recommend that a well-designed and focused assessment is needed to identify the functional ability and stroke-related health problems among individuals by all healthcare professionals for the successful rehabilitation of stroke survivors.

Altered cerebellar functional connectivity in chronic subcortical stroke patients.

Previous studies demonstrated that cerebellar subregions are involved in different functions. Especially the cerebellar anterior lobe (CAL) and cerebellar posterior lobe (CPL) have been postulated to primarily account for sensorimotor and cognitive function, respectively. However, the functional connectivity (FC) alterations of CAL and CPL, and their relationships with behavior performance in chronic stroke participants are unclear so far. The present study collected resting-state fMRI data from thirty-six subcortical chronic stroke participants and thirty-eight well-matched healthy controls (HCs). We performed the FC analysis with bilateral CAL and CPL as seeds for each participant. Then, we detected the FC difference between the two groups by using a two-sample t-test and evaluated the relationship between the FC and scores of motor and cognitive assessments across all post-stroke participants by using partial correlation analysis. The CAL showed increased FCs in the prefrontal cortex, superior/inferior temporal gyrus, and lingual gyrus, while the CPL showed increased FCs in the inferior parietal lobule, precuneus, and cingulum gyrus in the stroke participants compared with HCs. Moreover, the FC alteration in the right CAL and the right CPL were negatively correlated with executive and memory functions across stroke participants, respectively. These findings shed light on the different increased FC alteration patterns of CAL and CPL that help understand the neuro-mechanisms underlying behavior performance in chronic stroke survivors.

Impairments in the mechanical effectiveness of reactive balance control strategies during walking in people post-stroke.

People post-stroke have an increased risk of falls compared to neurotypical individuals, partly resulting from an inability to generate appropriate reactions to restore balance. However, few studies investigated the effect of paretic deficits on the mechanics of reactive control strategies following forward losses of balance during walking. Here, we characterized the biomechanical consequences of reactive control strategies following perturbations induced by the treadmill belt accelerations. Thirty-eight post-stroke participants and thirteen age-matched and speed-matched neurotypical participants walked on a dual-belt treadmill while receiving perturbations that induced a forward loss of balance. We computed whole-body angular momentum and angular impulse using segment kinematics and reaction forces to quantify the effect of impulse generation by both the leading and trailing limbs in response to perturbations in the sagittal plane. We found that perturbations to the paretic limb led to larger increases in forward angular momentum during the perturbation step than perturbations to the non-paretic limb or to neurotypical individuals. To recover from the forward loss of balance, neurotypical individuals coordinated reaction forces generated by both legs to decrease the forward angular impulse relative to the pre-perturbation step. They first decreased the forward pitch angular impulse during the perturbation step. Then, during the first recovery step, they increased the backward angular impulse by the leading limb and decreased the forward angular impulse by the trailing limb. In contrast to neurotypical participants, people post-stroke did not reduce the forward angular impulse generated by the stance limb during the perturbed step. They also did not increase leading limb angular impulse or decrease the forward trailing limb angular impulse using their paretic limb during the first recovery step. Lastly, post-stroke individuals who scored poorer on clinical assessments of balance and had greater motor impairment made less use of the paretic limb to reduce forward momentum. Overall, these results suggest that paretic deficits limit the ability to recover from forward loss of balance. Future perturbation-based balance training targeting reactive stepping response in stroke populations may benefit from improving the ability to modulate paretic ground reaction forces to better control whole-body dynamics.

Continuous cardiac rhythm monitoring post-stroke: A feasibility study in REGARDS

ObjectivesCardiac rhythm monitoring is increasingly used after stroke. We studied feasibility of telephone guided, mail-in ambulatory long-term cardiac rhythm monitoring in Black and White stroke survivors. Materials and methods;We contacted 28 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who had an ischemic stroke during follow-up. After obtaining informed consent by telephone, a noninvasive 14-day cardiac rhythm monitoring device (ZIO® XT patch; iRhythm Technologies, San Francisco, CA) was mailed to each participant. We evaluated the results of telephone consent, follow-up calls, compliance and wear time as the primary objective. Secondarily, we reported prevalence of atrial and ventricular arrhythmias. ResultsThe majority of those contacted (20/28 = 71%) agreed to enroll in the monitoring study. Non-participation was nominally more common in Black than White participants; 6/16 (37.5%) vs. 2/12 (17%). Of those who agreed, 15 participants (75%, 6 Black, 9 White) completed ambulatory monitoring with mean wear time 12.9 ± 2.5 days. Arrhythmias were observed in two-thirds of the 15 participants: AF in 2, brief atrial tachycardia in 12, NSVT in 2, premature ventricular contractions in 3, and pause or atrioventricular block in 2. ConclusionsNon-invasive rhythm monitoring was feasible in this pilot from a large, national cohort study of stroke survivors that employed a telephone guided, mail-in monitoring system, and these preliminary results suggest a high prevalence of arrhythmias. Increased emphasis on recruitment strategies for Black stroke survivors may be required. We demonstrated a high yield of significant cardiac arrhythmias among post-stroke participants who completed monitoring.