Lower limb motor function and hip muscle weakness in stroke survivors and their relationship with pelvic tilt, weight-bearing asymmetry, and gait speed: A cross-sectional study

2020 ◽  
Author(s):  
Vishakha Darak ◽  
Suruliraj Karthikbabu
Keyword(s):  
Lower Extremity ◽  
Motor Function ◽  
Muscle Weakness ◽  
Gait Speed ◽  
Pelvic Tilt ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Hip Muscle ◽  
Walking Capacity ◽  
Hip Muscles

Background: Poor motor recovery of hip muscles affect the walking post-stroke. The study objective was to examine how lower extremity motor function and hip muscle weakness are related to weightbearing asymmetry (WBA), excessive pelvic tilt, and gait speed in stroke survivors. Methods: Eighty patients with chronic stroke, a mean and standard deviation (SD) of post-stroke duration of 350 ± 664 days, age of 30-70 years, independent standing, and 10-meter walking capacity participated in the study. Hip muscular strength was measured using a handheld dynamometer (HHD) and motor function was assessed by Fugl-Meyer Assessment of lower extremity (FMA-LE). The WBA was recorded using two weighing scales; whereas the pelvic tilt and gait speed were evaluated using palpation meter (PALM) and 10-meter walk test, respectively. Results: The muscles strength of hip flexors, extensors, abductors, and adductors of the paretic side ranged between 22.0 and 24.4 pounds. The mean score of FMA-LE was 22 points. Following Pearson product-moment correlation with statistically significant P < 0.05, the relationship of hip muscles strength and FMA with WBA, lateral pelvic tilt (LPT) and anterior pelvic tilt (APT), and speed are as follows: flexors (r = 0.47, r = 0.31, r = 0.44, r = 0.44), extensors (r = 0.45, r = 0.38, r = 0.37, r = 0.35), abductors (r = 0.49, r = 0.32, r = 0.38, r= 0.40), adductors (r = 0.45, r = 0.31, r = 0.23, r = 0.34), and motor function (r = 0.62, r = 0.33, r = 0.38, r = 0.62).    

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

Trajectory of Motor Performance Over Twelve Months in Nigerian Stroke Survivors

2014 ◽  
Vol 15 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Grace Oluwatitofunmi Vincent-Onabajo ◽  
Talhatu Kolapo Hamzat ◽  
Mayowa Ojo Owolabi
Keyword(s):  
Lower Extremity ◽  
Upper Extremity ◽  
Motor Performance ◽  
First Year ◽  
Stroke Survivors ◽  
Health Institution ◽  
Post Stroke ◽  
Severe Impairment ◽  
Upper And Lower Extremities

Objective: Submissions on recovery of post-stroke motor performance vary, especially in relation to increasing time after stroke. This study examined the trajectory of motor performance over the first 12 months after stroke.Methods: Consecutive first-incidence stroke survivors (N = 83) were recruited within 1 month of onset from a tertiary health institution in Nigeria. Simplified Fugl Meyer scale (S-FM) was used to assess motor performance at monthly intervals. Changes in overall motor performance, and differences between the affected upper and lower extremities, were examined using Friedman's ANOVA and paired t-tests, respectively.Results: Significant improvement in motor performance was observed across 12 months (p < .001), with the proportion of stroke survivors with severe impairment at onset (53.3%) decreasing to 20% by 12 months. Lower extremity motor performance scores were significantly higher than for the upper extremity from 1 to 12 months (p <.01 at 3, 4, 5, 6 and 12 months; and p < .05 at the remaining months).Conclusions: The potential for long-term improvement in motor performance after stroke was observed, suggesting that this can be harnessed by long-term rehabilitation efforts. The comparatively poorer outcome in the upper extremity indicates the need for extra rehabilitation strategies to enhance upper-extremity motor recovery in the first year of stroke.

scholarly journals Effectiveness of combined modified constraint-induced movement therapy for upper and lower limb in stroke rehabilitation: a study protocol for randomized controlled trial (Preprint)

2018 ◽  
Author(s):  
Lawan Umar
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Gait Speed ◽  
Stride Length ◽  
Controlled Trial ◽  
Stroke Survivors ◽  
Hrqol Score ◽  
Randomized Controlled ◽  
Post Hoc

BACKGROUND Background: The translation of neuroscientific research into care has led to new approaches and renewed promise. Stroke survivors with hemiparesis often exhibit impaired balance, ambulation dysfunction and asymmetrical weight distribution leading to physical dysfunction and decreased Health-Related Quality of Life (HRQoL).Constraint-induced movement therapy (CIMT) approach could be translated into a clinical protocol for gait rehabilitation. Modified CIMT for upper limb and lower limb when applied singly improve lower limb motor function, balance, gait and HRQoL of stroke survivors OBJECTIVE However, effects of combined modified CIMT for upper and lower limbs (CoMCIMTULL) have not been investigated. Therefore, the effects of four-week CoMCIMTULL was compared with Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) among hemiparetic stroke survivors in this study. METHODS This single-blind randomized controlled trial involved random assignment of 56 consecutive stroke survivors to three groups: CoMCIMTULL (n=19), MCIMTLL (n=20), and MCIMTUL (n=17). The CoMCIMTULL group received both upper and lower limb CIMT for the reduced use of the upper limb and maladaptive use of the lower limb. The MCIMTLL group used the affected lower limb to lead weight bearing activities and exercises while the MCIMTUL group used the affected upper limbs for motor task practice following the unaffected hand’s restraining in a special splint. These treatments were administared in the clinic for two hours daily, five times per week for four consecutive weeks. Lower Limb Motor Function (LLMF) and balance were assessed using Fugyl Meyer Motor Assessement Scale, Lower Limb Use (LLU) with Lower Extremity Motor Activity Log, balance confidence using Activities-specific Balance Confidence Scale, Weight Asymmetry Ratio (WAR) using two weighing scales, spatiotemporal gait parameters [gait speed (m/s) and stride length (m)] using foot print method and HRQoL using the Stroke Impact Scale. These assessments were done at baseline, ends of weeks two and four. Data were analysed using descriptive statistics, ANOVA with post-hoc, Kruskal-Wallis with post-hoc and Wilcoxon Signed Rank at ᾳ0.05. RESULTS MBetween-group comparisons showed that the differences were significant in CoMCIMTULL (HRQoL score=70.00(10.00) ; LLMF = 29.00(5.00); gait speed=0.650(0.70)m/s ; Stride length=0.60(0.30)m ; and WAR=0.90(0.80) ) compared to MCIMTLL (HRQoL score=80.00(17.50); LLMF =29.50(2.50) ; gait speed=0.80(0.28)m/s; Stride length=0.65(0.40)m; and WAR=0.85(0.40) and MCIMTUL (HRQoL score= 60.00(10.00; LLMF =26.00(4.00) ; gait speed= 0.60(0.20)m/s;Stride length= 0.40(0.40)m; and WAR= 0.80(0.40) CONCLUSIONS It is expected, the outcome of this study will clarify whether the effect of combined modified CIMT upper and lower limb (CoMCIMTULL), Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) will leads to better recovery of motor function in stroke survivors. CLINICALTRIAL This study has been approved by both Health Research Ethics Committee of Universty of Ibadan/University College Hospital (UI/EC/14/0101) and the Murtala Muhammad Specialist Hospital, Kano (HMB/GEN/488/VOL.I)(Nigeria). Additionaly, the study employed a randomized controlled clinical trial design, registered with Pan Africa Clinical Trial Registry PACTR 201611001646207, available on www.pactr.org.

Abstract 46: A New Rehabilitation Strategy to Improve Gait Speed and Balance Self-Efficacy Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dorian K Rose ◽  
Lou DeMark ◽  
Christy Conroy ◽  
Emily Fox ◽  
David Clark
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Fall Risk ◽  
Step Length ◽  
Walk Test ◽  
Post Intervention ◽  
Backward Walking ◽  
Balance Confidence ◽  
Post Stroke ◽  
Abc Scale

Introduction: Impaired balance and decreased balance confidence contribute to slow gait speed and increased fall risk post-stroke. Standard balance exercises and gait training do not adequately address these impairments. Backward Walking Training (BWT), incorporating the unique postural and lower extremity motor control demands of walking backward, may reduce these gait impairments. This study compared the effects of BWT to Forward Walking Training (FWT) on forward and backward gait speed, dynamic balance and balance confidence. Methods: Thirty adults with first time stroke (18 male; 15 right hemisphere lesion; mean time post-stroke 12.7±6.6 months; mean age 58.8±10.1 yrs; mean Lower Extremity Fugl-Meyer Motor Score 22.7±1.4) were randomized to receive eighteen exercise sessions (3x/week for 6 weeks) of BWT (n=15) or FWT (n=15) consisting of 20 minutes training on a treadmill with Body Weight Support followed by 20 minutes overground. Gait was facilitated by a physical therapist-led team. Speed, limb loading and bout duration were progressed across sessions. The Ten Meter Walk Test (10MWT), Activities-Specific Balance Confidence (ABC) Scale, 3-meter Backward Walk Test (3MBWT), Functional Gait Assessment (FGA) and spatial-temporal gait characteristics were assessed pre- and post-intervention. Results: Pre- to post-intervention increases in the 3MBWT (BWT: 0.23±0.4 to 0.32±0.06 m/s ; FWT 0.21±0.4 to 0.23±0.04 m/s: ), ABC (BWT: 55.2±5.2% to 61.8±7.1% ; FWT: 52.9±6.5% to 53.5±6.2%: ), 10MWT (BWT: 0.42±0.07 to 0.51±0.08 m/s ; FWT: 0.44±0.08 to 0.47±0.07 m/s ) and backward paretic step length (BWT: 0.19±0.04 to 0.34±0.03 cm ; FWT: 0.21±0.03 to 0.20±0.04 cm were greater for the BWT than the FWT group. These gains were all statistically significant (p < 0.01). Group differences in FGA did not reach statistical significance. Conclusions: The greater increase in backward paretic step length, backward walking speed and balance confidence observed in the BWT group are all known contributors to reduced fall risk. BWT may be an important addition to the rehabilitation plan for individuals post-stroke. A longitudinal examination of fall incidence following BWT is the next important step in determining the overall utility of this novel rehabilitation approach.

Hip-Muscle Activation during the Lunge, Single-Leg Squat, and Step-Up-and-Over Exercises

2009 ◽  
Vol 18 (1) ◽  
pp. 91-103 ◽  
Author(s):  
Samantha N. Boudreau ◽  
Maureen K. Dwyer ◽  
Carl G. Mattacola ◽  
Christian Lattermann ◽  
Tim L. Uhl ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Outcome Measures ◽  
Muscle Activation ◽  
Gluteus Maximus ◽  
Rectus Femoris ◽  
Lower Extremity Injury ◽  
Cross Sectional ◽  
Hip Muscle ◽  
Hip Muscles ◽  
Single Leg Squat

Context:Functional exercises are often used in strengthening programs after lower extremity injury. Activation levels of the stabilizing hip muscles have not been documented.Objective:To document the progression of hip-muscle activation levels during 3 lower extremity functional exercises.Design:Cross-sectional.Setting:Laboratory.Participants:44 healthy individuals, 22 women and 22 men.Intervention:Subjects, in 1 testing session, completed 3 trials each of the lunge (LUN), single-leg squat (SLSQ), and step-up-and-over (SUO) exercise.Main Outcome Measures:Root-mean-square muscle amplitude (% reference voluntary muscle contraction) was measured for 5 muscles during the 3 exercises: rectus femoris (RF), dominant and nondominant gluteus medius (GMed_D and GMed_ND), adductor longus (ADD), and gluteus maximus (GMX).Results:The RF, GMAX, and GMed_D were activated in a progression from least to greatest during the SUO, LUN, and SLSQ. The progression for the GMed_ND activation was from least to greatest during the SLSQ, SUO, and then LUN. Activation levels of the ADD showed no progression.Conclusion:Progressive activation levels were documented for muscles acting on the hip joint during 3 functional lower extremity exercises. The authors recommend using this exercise progression when targeting the hip muscles during lower extremity strengthening.

Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis

2017 ◽  
Vol 32 (9) ◽  
pp. 1203-1219 ◽  
Author(s):  
Patrick WH Kwong ◽  
Gabriel YF Ng ◽  
Raymond CK Chung ◽  
Shamay SM Ng
Keyword(s):  
Lower Extremity ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Meta Analysis ◽  
Motor Recovery ◽  
Controlled Trials ◽  
Stroke Survivors ◽  
Plantar Flexor ◽  
Electrical Nerve Stimulation ◽  
Walking Capacity

Objective: To evaluate (1) the effectiveness of transcutaneous electrical nerve stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation parameters for TENS. Review methods: A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery in stroke survivors were assessed for inclusion. Outcomes of interest included plantar flexor spasticity, muscle strength, walking capacity and balance. Results: In all, 11 studies met the inclusion criteria which involved 439 stroke survivors. The meta-analysis showed that TENS improved walking capacity, as measured by either gait speed or the Timed Up and Go Test (Hedges’ g = 0.392; 95% confidence interval (CI) = 0.178 to 0.606) compared to the placebo or no-treatment control groups. TENS also reduced paretic plantar flexor spasticity, as measured using the Modified Ashworth Scale and Composite Spasticity Scale (Hedges’ g = –0.884; 95% CI = –1.140 to −0.625). The effect of TENS on walking capacity in studies involving 60 minutes per sessions was significant (Hedges’ g = 0.468; 95% CI = 0.201–0.734) but not in study with shorter sessions (20 or 30 minutes) (Hedges’ g = 0.254; 95% CI = –0.106–0.614). Conclusion: The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors.

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