Training In Stroke Patients Research Articles

Outcome of strategy training in stroke patients with apraxia: a phase II study

Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. The outcome was studied in a pre-post test design. Measurements were conducted at baseline and 12 weeks later. Thirty-three stroke patients with apraxia were treated at occupational therapy departments n general hospitals, rehabilitation centres and nursing homes. The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient. The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved. These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.

Outcome of strategy training in stroke patients with apraxia: a phase II study

Objective: Evaluation of a therapy programme for stroke patients with apraxia. The programme is based on teaching patients strategies to compensate for the presence of apraxia. This programme was designed for assessment and treatment by occupational therapists. Design: The outcome was studied in a pre–post test design. Measurements were conducted at baseline and 12 weeks later. Subjects: Thirty-three stroke patients with apraxia were treated at occupational therapy departments in general hospitals, rehabilitation centres and nursing homes. Main outcome measures: The following measurements were conducted: an apraxia test, a motor functioning test, observation of activities of daily living (ADL), Barthel Index, and an ADL questionnaire for the therapist and the patient. Results: The patients showed large improvements in ADL functioning on all measures and small improvements on the apraxia test and the motor functioning test. The effect sizes for the disabilities, ranging from 0.92 to 1.06, were large compared to the effect sizes for apraxia (0.34) and motor functioning (0.19). The significant effect of treatment is also seen when individual improvement and subjective improvement are considered. Measured with the Barthel Index for instance, 71% of the patients improved. Conclusions: These results suggest that the programme seems to be successful in teaching patients compensatory strategies that enable them to function more independently, despite the lasting presence of apraxia.

Benefits of aerobic exercise after stroke.

The debilitating loss of function after a stroke has both primary and secondary effects on sensorimotor function. Primary effects include paresis, paralysis, spasticity, and sensory-perceptual dysfunction due to upper motor neuron damage. Secondary effects, contractures and disuse muscle atrophy, are also debilitating. This paper presents theoretical and empirical benefits of aerobic exercise after stroke, issues relevant to measuring peak capacity, exercise training protocols, and the clinical use of aerobic exercise in this patient population. A stroke, and resulting hemiparesis, produces physiological changes in muscle fibres and muscle metabolism during exercise. These changes, along with comorbid cardiovascular disease, must be considered when exercising stroke patients. While few studies have measured peak exercise capacity in hemiparetic populations, it has been consistently observed in these studies that stroke patients have a lower functional capacity than healthy populations. Hemiparetic patients have low peak exercise responses probably due to a reduced number of motor units available for recruitment during dynamic exercise, the reduced oxidative capacity of paretic muscle, and decreased overall endurance. Consequently, traditional methods to predict aerobic capacity are not appropriate for use with stroke patients. Endurance exercise training is increasingly recognised as an important component in rehabilitation. An average improvement in maximal oxygen consumption (VO2max) of 13.3% in stroke patients who participated in a 10-week aerobic exercise training programme has been reported compared with controls. This study underscored the potential benefits of aerobic exercise training in stroke patients. In this paper, advantages and disadvantages of exercise modalities are discussed in relation to stroke patients. Recommendations are presented to maximise physical performance and minimise potential cardiac risks during exercise.

Dynamic muscle strength training in stroke patients: Effects on knee extension torque, electromyographic activity, and motor function

The effects of training with isokinetic maximal voluntary knee extensions were studied in stroke patients. Two groups of 10 patients each trained twice a week for 6 weeks. One group trained exclusively eccentric movements and the other exclusively concentric movements. The effects were evaluated from the following tests before and after the training period. The maximal voluntary strength in concentric and eccentric actions of the knee extensor and flexor muscles was recorded together with surface electromyography at constant velocities of 60, 120, and 180 deg·s −1 on three different days. The body weight distribution on the legs while rising and sitting down was measured with two force plates. The self-selected and maximal walking speeds and the swing to stride ratio of the paretic leg were measured. After the training period, the knee extensor strength had increased in eccentric and concentric actions in both groups ( p < .05). The eccentric and the concentric strength in the paretic leg relative to that of the nonparetic leg increased in the eccentrically trained group ( p < .05) but not in the concentrically trained group. The restraint of the antagonistic muscles in concentric movements increased after concentric ( p < .05) but not eccentric training. A nearly symmetrical body weight distribution on the legs in rising from a sitting position was noted after eccentric ( p < .05) but not concentric training. Changes in walking variables were not significantly different between the groups. Eccentric knee extensor training was thus found to have some advantages as compared to concentric training in stroke patients.