Abstract P276: Aerobic Endurance and Leg Strength are Predictive of Gait Velocity among Community-Dwelling Stroke Survivors

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Ruth E Taylor-Piliae ◽  
L. Daniel Latt ◽  
Bruce M Coull
Keyword(s):  
Cognitive Impairment ◽  
Functional Disability ◽  
Chronic Stroke ◽  
Community Dwelling ◽  
Step Test ◽  
Gait Velocity ◽  
Stroke Survivors ◽  
Chair Stand ◽  
Post Stroke ◽  
Leg Strength

Background: Gait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance and paretic leg strength, with one or both of these conditions affecting their gait velocity. Other reported underlying factors affecting gait velocity include functional disability, balance and cognitive impairment. Objective: To examine potential independent predictors of gait velocity in chronic stroke. Methods: Cross-sectional design using baseline data from the first 100 community-dwelling stroke survivors enrolled in an exercise intervention study. Eligible subjects included men and women aged ≥ 50 years and at ≥ 3 months post-stroke. Subjects completed a comprehensive, self-administered health survey prior to their baseline study visit. At the baseline visit, functional disability (Modified Rankin Scale), aerobic endurance (2-minute step-test), leg strength (timed 5-chair stand test), balance (single-leg stance) and cognitive impairment (Mini-Mental Status Exam) were assessed. Gait speed was assessed using a valid and reliable timed 4-meter walk test designed for older adults with disabilities; to calculate gait velocity (meters/second). Multiple linear regression was conducted to explore potential independent predictors of gait velocity. Results: Subjects (n=100) were on average 70±10 years old, and 39±49 months post-stroke. The majority reported an ischemic stroke (68/100) with hemiparesis (80/100); and were married (59/100), White/European-American (78/100), college-educated (79/100), men (54/100). Subjects had an average gait velocity of 0.75±0.23 meters/second, categorized as limited community walkers. Approximately 37% of the variance in gait velocity, could be explained by the optimal combination of the independent variables in the model: functional disability, aerobic endurance, leg strength, balance, and cognitive impairment (R 2 =0.37, F 5,74 =8.64, p<0.01). Only better aerobic endurance (t 1,74 =3.41, p<0.01) and leg strength (i.e. faster chair stand time) (t 1,74 =–2.23, p=0.03) contributed uniquely and significantly to faster gait velocity. Conclusion: A hallmark of gait dysfunction in chronic stroke is slow gait velocity, even among well-educated, community-dwelling survivors. Gait velocity is simple to measure requiring only a stopwatch and flat surface for walking. Our findings are similar to reports by others that diminished aerobic endurance and leg strength are major contributors to slow gait velocity in chronic stroke. Long term rehabilitation efforts are needed to improve gait velocity in chronic stroke, and may need to incorporate multifaceted strategies concurrently, focusing on aerobic endurance and leg strength, to maximize community ambulation and reintegration.

Personal and social factors that influence physical activity levels in community-dwelling stroke survivors: A systematic review of qualitative literature

2021 ◽  
pp. 026921552199369
Author(s):  
Karl R Espernberger ◽  
Natalie A Fini ◽  
Casey L Peiris
Keyword(s):  
Physical Activity ◽  
Social Factors ◽  
Self Efficacy ◽  
Data Extraction ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Activity Levels ◽  
Post Stroke ◽  
Physical Activity Levels ◽  
Mobile Community

Objectives: To determine the personal and social factors perceived to influence physical activity levels in stroke survivors. Data sources: Four electronic databases (MEDLINE, CINAHL, PubMed and Embase) were searched from inception to November 2020, including reference and citation list searches. Study selection: The initial search yielded 1499 papers, with 14 included in the review. Included articles were peer-reviewed, qualitative studies, reporting on the perceived factors influencing physical activity levels of independently mobile community-dwelling adults, greater than 3 months post stroke. Data extraction: Data extracted included location, study aim, design, participant and recruitment information and how data were collected and analysed. Data synthesis: Thematic analysis was undertaken to identify meanings and patterns, generate codes and develop themes. Five main themes were identified: (i) Social networks are important influencers of physical activity; (ii) Participation in meaningful activities rather than ‘exercise’ is important; (iii) Self-efficacy promotes physical activity and physical activity enhances self-efficacy; (iv) Pre-stroke identity related to physical activity influences post-stroke physical activity; and (v) Formal programmes are important for those with low self-efficacy or a sedentary pre-stroke identity. Conclusions: Physical activity levels in stroke survivors are influenced by social activities and support, pre-stroke identity, self-efficacy levels and completion of activities that are meaningful to stroke survivors.

scholarly journals Association among depression, cognitive impairment and executive dysfunction after stroke

2012 ◽  
Vol 6 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Luisa Terroni ◽  
Matildes F.M. Sobreiro ◽  
Adriana B. Conforto ◽  
Carla C. Adda ◽  
Valeri D. Guajardo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Tests ◽  
Executive Dysfunction ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Adequate Treatment ◽  
Post Stroke ◽  
Quantitative Studies ◽  
Post Stroke Depression ◽  
The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

Abstract TP150: Two Weeks of Ischemic Preconditioning Training on the Paretic Leg Improves Leg Strength and Delays Muscle Fatigue in Chronic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Matthew J Durand ◽  
Spencer A Murphy ◽  
Brian D Schmit ◽  
David D Gutterman ◽  
Allison S Hyngstrom
Keyword(s):  
Motor Function ◽  
Ischemic Preconditioning ◽  
Vascular Function ◽  
Knee Extensor ◽  
Chronic Stroke ◽  
Muscle Performance ◽  
Walking Ability ◽  
Post Stroke ◽  
Leg Strength ◽  
Improve Motor Function

Introduction: Individuals living with chronic stroke have weakness and increased neuromuscular fatigue in the paretic leg, which can limit walking ability and endurance. In cardiac and healthy populations, ischemic preconditioning (IPC) is a widely studied, effective, non-invasive stimulus which not only improves vascular function, but also motor performance. IPC occurs when the tissue of interest is exposed to repeated, short bouts of ischemia, which can improve motor function by enhancing vascular, neural and muscle function. IPC has not been tested as a method to improve motor function in individuals post-stroke. Hypothesis: Two weeks of IPC training on the paretic leg will improve leg strength and time-to-task failure (TTF) during a fatiguing muscle contraction. Methods: A feasibility study of 4 individuals (3 female, 1 male) with chronic stroke (20 ± 4 years) was conducted. A Biodex dynamometer was used to assess paretic leg knee extensor maximal voluntary contraction (MVC). To assess muscle fatigability, subjects maintained a sustained contraction equal to 30% of their MVC until failure using visual feedback. After baseline testing, subjects made six visits to the laboratory over a two week period to have IPC performed on their paretic leg. A blood pressure cuff was inflated on the thigh to 225 mmHg for five, five-minute bouts per session. Five minutes of rest was given between inflation cycles. After the last session, subjects returned within 48 hours to have MVC and TTF reassessed. Results: Three subjects completed all study procedures. One subject withdrew for medical reasons unrelated to the study. The IPC procedure was well tolerated by all subjects. After two-week IPC training, knee extensor MVC increased in the paretic leg (45.0 ± 2.7 Nm vs. 52.6 ± 5.7 Nm). Fatigability of the muscles was dramatically reduced after IPC training as TTF tripled (359 ± 180 seconds vs. 1097 ± 343 seconds). Conclusions: We are the first group to show that IPC is a well-tolerated and effective stimulus to improve paretic leg strength and reduce muscle fatigability in subjects with chronic stroke. The results of this pilot study warrant a larger study to determine whether IPC improves muscle performance post-stroke through neural, vascular, or muscle-related mechanisms.

scholarly journals Influence of Chronic Stroke on Functional Arm Reaching: Quantifying Deficits in the Ipsilesional Upper Extremity

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Savitha Subramaniam ◽  
Rini Varghese ◽  
Tanvi Bhatt
Keyword(s):  
Reaction Time ◽  
Upper Extremity ◽  
Movement Time ◽  
Chronic Stroke ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Initiation Time ◽  
Peak Acceleration ◽  
Movement Initiation ◽  
And Performance

Purpose. The purpose of this study was to quantify ipsilesional upper extremity (UE) stand-reaching performance (kinematics and kinetics) among chronic stroke survivors.Method. Community-dwelling chronic stroke survivors (n=13) and age-similar healthy adults (n=13) performed flexion- and abduction-reaching tasks. Surface EMG and acceleration were sampled using wireless sensors from the prime movers (anterior and middle deltoid) and provided performance-outcome (reaction time, burst duration, movement time, and movement initiation time) and performance-production (peak acceleration) measures and were then evaluated.Results. Individuals with chronic stroke demonstrated significantly reduced performance outcomes (i.e., longer reaction time, burst duration, movement time, and movement initiation time) and performance production ability (i.e., smaller peak acceleration) compared to their healthy counterparts (p< 0.05) for both flexion- and abduction-reaching movements.Conclusion. Our results are suggestive of post-stroke deficits in ipsilesional motor execution during a stand-reaching task. Based on these findings, it is essential to integrate ipsilesional UE training into rehabilitation interventions as this might aid functional reaching activities of daily living and could ultimately help community-dwelling chronic stroke survivors maintain their independent living.

Respiratory Pressures and Thoracoabdominal Motion in Community-Dwelling Chronic Stroke Survivors

2005 ◽  
Vol 86 (10) ◽  
pp. 1974-1978 ◽  
Author(s):  
Luci F. Teixeira-Salmela ◽  
Verônica F. Parreira ◽  
Raquel R. Britto ◽  
Tereza C. Brant ◽  
Érika P. Inácio ◽  
...  
Keyword(s):  
Chronic Stroke ◽  
Community Dwelling ◽  
Stroke Survivors

Exploring the experience of post-stroke fatigue in community dwelling stroke survivors: a prospective qualitative study

2012 ◽  
Vol 34 (16) ◽  
pp. 1376-1384 ◽  
Author(s):  
Jennifer Helen White ◽  
Kimberley R. Gray ◽  
Parker Magin ◽  
John Attia ◽  
Jonathan Sturm ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Community Dwelling ◽  
Stroke Survivors ◽  
Post Stroke

scholarly journals Relationship between Post-Stroke Cognitive Impairment and Functional Activity of Stroke Survivors in Maiduguri, Borno State Nigeria

2019 ◽  
Vol 09 (01) ◽  
pp. 8-22
Author(s):  
Abdulsalam Abdullah ◽  
Abubakar Umar ◽  
M. A. Abdulkadir ◽  
Muhammad Abdullahi Sa’id Bmr ◽  
Jimada Yahaya Danladi
Keyword(s):  
Cognitive Impairment ◽  
Functional Activity ◽  
Stroke Survivors ◽  
Post Stroke

scholarly journals Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia

2021 ◽  
Vol 12 ◽  
Author(s):  
Kwong Hsia Yap ◽  
Narelle Warren ◽  
Pascale Allotey ◽  
Daniel Reidpath
Keyword(s):  
Cognitive Impairment ◽  
Case Studies ◽  
Community Dwelling ◽  
Rural Setting ◽  
Term Care ◽  
Middle Income ◽  
Treatment Pathways ◽  
Behavioural Symptoms ◽  
Post Stroke ◽  
Middle Income Countries

Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.

scholarly journals Facilitating Exercise Engagement among Community Dwelling Stroke Survivors: Is a once Per Week Group Session Sufficient?

2019 ◽  
Vol 16 (23) ◽  
pp. 4746
Author(s):  
Nor Azlin Mohd Nordin ◽  
Nor Asma Husna Yusoff ◽  
Devinder Kaur Ajit Singh
Keyword(s):  
Physical Performance ◽  
Low Frequency ◽  
Community Dwelling ◽  
Exercise Session ◽  
Stroke Recurrence ◽  
Stroke Survivors ◽  
Group Exercise ◽  
Post Stroke ◽  
Sit To Stand ◽  
Balance Ability

Although exercise is proven as an effective strategy to combat post-stroke complications and the risk of stroke recurrence, many stroke survivors fail to engage in this activity following rehabilitation. In this study, we assessed the feasibility and usefulness of a low-frequency group exercise to determine its suitability as an approach to facilitate exercise engagement among stroke survivors. Forty-one stroke survivors, mean (SD) age 59.34 (10.02) years, mean time post-stroke 17.13 (17.58) months, completed a 90 minute, once per week, group exercise supervised by therapists for 12 weeks. The exercise outcomes were measured using standardized clinical tests. We observed improvement in the group’s physical performance; balance score by 3 units (Z = −3.88, p < 0.001), speed of repetitive sit to stand by 3.4 s (Z = −4.69, p < 0.001), and walking speed by 8.22 m/min (Z = −3.25, p < 0.001). Scores of seven out of 14 Berg’s balance scale items increased significantly, indicating better balance ability among the survivors. In conclusion, a 12-week, once per week group exercise session seems feasible and sufficient to improve the physical performance of community dwelling stroke survivors. This exercise arrangement may be offered to stroke survivors to facilitate exercise practice following rehabilitation.

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