scholarly journals Innovative Long-Dose Neurorehabilitation for Balance and Mobility in Chronic Stroke: A Preliminary Case Series

2020 ◽  
Vol 10 (8) ◽  
pp. 555
Author(s):  
Catherine Boissoneault ◽  
Tyler Grimes ◽  
Dorian K. Rose ◽  
Michael F. Waters ◽  
Anna Khanna ◽  
...  
Keyword(s):  
Gait Speed ◽  
Case Series ◽  
Functional Independence ◽  
Limb Movement ◽  
Chronic Stroke ◽  
Small Sample ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Convenience Sample ◽  
Long Duration

(1) Objective: The objective was two-fold: (a) test a protocol of combined interventions; (b) administer this combined protocol within the framework of a six-month, intensive, long-duration program. The array of interventions was designed to target the treatment-resistant impairments underlying persistent mobility dysfunction: weakness, balance deficit, limb movement dyscoordination, and gait dyscoordination. (2) Methods: A convenience sample of eight chronic stroke survivors (>4 months post stroke) was enrolled. Treatment was 5 days/week, 1–2.5 h/day for 6 months, as follows: strengthening exercise, balance training, limb/gait coordination training, and aerobic exercise. Outcome measures: Berg Balance Scale (BBS), Fugl-Meyer Lower Limb Coordination (FM), gait speed, 6 Minute Walk Test (6MWT), Timed up and Go (TUG), Functional Independence Measure (FIM), Craig Handicap Assessment Rating Tool (CHART), and personal milestones. Pre-/post-treatment comparisons were conducted using the Permutation Test, suitable for ordinal measures and small sample size. (3) Results: For the group, there was a statistically (p ≤ 0.04) significant improvement in balance, limb movement coordination (FM), gait speed, functional mobility (TUG), and functional activities (FIM). There were measurable differences (minimum detectible change: MDC) in BBS, FM, gait speed, 6MWT, and TUG. There were clinically significant milestones achieved for selected subjects according to clinical benchmarks for the BBS, 6MWT, gait speed, and TUG, as well as achievement of personal milestones of life role participation. Effect sizes (Cohen’s D) ranged from 0.5 to 1.0 (with the exception of the (6MWT)). After six months of treatment, the above array of gains were beyond that reported by other published studies of chronic stroke survivor interventions. Personal milestones included: walking to mailbox, gardening/yardwork, walking a distance to neighbors, return to driving, membership at a fitness center, vacation trip to the beach, swimming at local pool, returning to work, housework, cooking meals. (4) Conclusions: Stroke survivors with mobility dysfunction were able to participate in the long-duration, intensive program, with the intervention array targeted to address impairments underlying mobility dysfunction. There were either clinically or statistically significant improvements in an array of measures of impairment, functional mobility, and personal milestone achievements.

Abstract WP167: Timed Up and Go Test With an Obstacle (TUGO): Reliability and Its Association With Motor Functions in People With Chronic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shamay S Ng
Keyword(s):  
Intraclass Correlation ◽  
Functional Independence ◽  
Chronic Stroke ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Balance Performance ◽  
Timed Up And Go ◽  
Motor Functions ◽  
Step Over ◽  
Completion Times

Introduction: Negotiating obstacles during walking is challenging and demanding for stroke survivors and it is a common cause of falls. As ability to negotiate obstacles is essential for community ambulation and functional independence in stroke survivors, assessing the ability to negotiate obstacles should be a crucial element in stroke rehabilitation. The Timed Up and Go Test with an Obstacle (TUGO), which is the modified from the Timed Up and Go (TUG) test, could be used to assess the ability to negotiate obstacles. In TUGO, subjects were required to stand up from a chair, walk forward for 5 meters, step over a 5-cm height obstacle which is placed at the end of 5-meter walkway, turn 180 0 , step over the obstacle again, walk back and sit down on the chair as fast as possible. Time required to complete the task was recorded by a stopwatch. The objectives of this study were to investigate the reliability of TUGO and its correlation with motor functions in people with chronic stroke. Method: This study was a cross-sectional study with 30 people with chronic stroke. TUGO completion times was administered along with Fugl-Meyer motor assessment for the lower extremities (FMA-LE), Berg Balance Scale (BBS) and timed Up and Go test (TUG). FMA-LE, BBS and TUG were used to assess motor control of the affected lower limb, clinical balance performance and functional mobility respectively. The TUGO was conducted in 2 separate sessions with 5-7days apart by 2 independent assessors. Result: TUGO completion times demonstrated excellent intra-rater, inter-rater and test-restest reliabilities, with intraclass correlation coefficients (ICCs) of 0.955-1.000. Significant correlations were also found between TUGO completion times and FMA-LE scores, BBS scores and TUG times respectively. Conclusion: TUGO is a reliable, valid and easy-to-administer clinical assessment for assessing the ability to negotiate obstacles in people with chronic stroke.

scholarly journals A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Marcia Belas dos Santos ◽  
Clarissa Barros de Oliveira ◽  
Arly dos Santos ◽  
Cristhiane Garabello Pires ◽  
Viviana Dylewski ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Controlled Trial ◽  
Gait Training ◽  
Functional Independence ◽  
Chronic Stroke ◽  
Wilcoxon Test ◽  
Stroke Survivors ◽  
Registration Number ◽  
One Year

Objectives. To assess the influence of RAGT on balance, coordination, and functional independence in activities of daily living of chronic stroke survivors with ataxia at least one year of injury.Methods. It was a randomized controlled trial.The patients were allocated to either therapist-assisted gait training (TAGT) or robotic-assisted gait training (RAGT). Both groups received 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each and prescribed home exercises. The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment: BBS, TUG test, FIM, and SARA. For intragroup comparisons, the Wilcoxon test was used, and the Mann–Whitney test was used for between-group comparison.Results. Nineteen stroke survivors with ataxia sequel after one year of injury were recruited. Both groups showed statistically significant improvement (P<0.05) in balance, functional independencein, and general ataxia symptoms. There were no statistically significant differences (P<0.05) for between-group comparisons both at baseline and after completion of the protocol.Conclusions. Chronic stroke patients with ataxia had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises. This trial was registered with trial registration number39862414.6.0000.5505.

scholarly journals Use of Visual and Proprioceptive Feedback to Improve Gait Speed and Spatiotemporal Symmetry Following Chronic Stroke: A Case Series

2012 ◽  
Vol 92 (5) ◽  
pp. 748-756 ◽  
Author(s):  
Michael D. Lewek ◽  
Jeff Feasel ◽  
Erin Wentz ◽  
Frederick P. Brooks ◽  
Mary C. Whitton
Keyword(s):  
Gait Speed ◽  
Case Series ◽  
Step Length ◽  
Gait Training ◽  
Chronic Stroke ◽  
Proprioceptive Feedback ◽  
Immersive Virtual Environment ◽  
Time Symmetry ◽  
Stance Time

Background and Purpose Persistent deficits in gait speed and spatiotemporal symmetry are prevalent following stroke and can limit the achievement of community mobility goals. Rehabilitation can improve gait speed, but has shown limited ability to improve spatiotemporal symmetry. The incorporation of combined visual and proprioceptive feedback regarding spatiotemporal symmetry has the potential to be effective at improving gait. Case Description A 60-year-old man (18 months poststroke) and a 53-year-old woman (21 months poststroke) each participated in gait training to improve gait speed and spatiotemporal symmetry. Each patient performed 18 sessions (6 weeks) of combined treadmill-based gait training followed by overground practice. To assist with relearning spatiotemporal symmetry, treadmill-based training for both patients was augmented with continuous, real-time visual and proprioceptive feedback from an immersive virtual environment and a dual belt treadmill, respectively. Outcomes Both patients improved gait speed (patient 1: 0.35 m/s improvement; patient 2: 0.26 m/s improvement) and spatiotemporal symmetry. Patient 1, who trained with step-length symmetry feedback, improved his step-length symmetry ratio, but not his stance-time symmetry ratio. Patient 2, who trained with stance-time symmetry feedback, improved her stance-time symmetry ratio. She had no step-length asymmetry before training. Discussion Both patients made improvements in gait speed and spatiotemporal symmetry that exceeded those reported in the literature. Further work is needed to ascertain the role of combined visual and proprioceptive feedback for improving gait speed and spatiotemporal symmetry after chronic stroke.

A wearable robotic knee orthosis for gait training: a case-series of hemiparetic stroke survivors

2011 ◽  
Vol 36 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Christopher Kevin Wong ◽  
Lauri Bishop ◽  
Joel Stein
Keyword(s):  
Case Series ◽  
Gait Training ◽  
Training Programme ◽  
Berg Balance Scale ◽  
Post Treatment ◽  
Functional Mobility ◽  
Stroke Survivors ◽  
Functional Training ◽  
Hemiparetic Stroke ◽  
Knee Orthosis

Background and Aim: Until recently, robotic devices for stroke rehabilitation had multi-joint designs that were often tethered to a treadmill for gait training. A new single-joint wearable robotic knee orthosis (RKO) has been designed that provides patient-initiated powered-assistance in untethered functional mobility. This case-series documents application of the wearable RKO in untethered functional training with stroke survivors.Technique: Three ambulatory adult stroke survivors used a wearable RKO during 18 one-hour sessions within a six-week physical therapy programme. Subjects were assessed with a variety of balance, gait and functional tests including the Berg Balance Scale (BBS); six-minute walk test (6MWT); and Emory Functional Ambulation Profile (EFAP) at pre-treatment, post-treatment, one-month and three-month follow-up.Discussion: All subjects improved balance, gait and functional performances with mean individual improvements of 12.6% for BBS, 12.0% for 6MWT and 16.7% for EFAP post-treatment. No adverse events occurred. These three stroke survivors may have benefited from the task-specific functional training programme augmented by RKO use.Clinical relevancePhysical therapists may find a wearable robotic knee orthosis useful for providing patient-initiated assisted movement for ambulatory chronic stroke survivors during functional task-specific balance and mobility training.

scholarly journals Task-specific training for improving propulsion symmetry and gait speed in people in the chronic phase after stroke: a proof-of-concept study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
J. F. Alingh ◽  
B. E. Groen ◽  
J. F. Kamphuis ◽  
A. C. H. Geurts ◽  
V. Weerdesteyn
Keyword(s):  
Gait Speed ◽  
Daily Life ◽  
Gait Training ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Proof Of Concept ◽  
Concept Study ◽  
Walking Activity ◽  
Robotic Gait ◽  
Functional Gait

Abstract Background After stroke, some individuals have latent, propulsive capacity of the paretic leg, that can be elicited during task-specific gait training. The aim of this proof-of-concept study was to investigate the effect of five-week robotic gait training for improving propulsion symmetry by increasing paretic propulsion in chronic stroke survivors. Methods Twenty-nine individuals with chronic stroke and impaired paretic propulsion (≥ 8% difference in paretic vs. non-paretic propulsive impulse) were enrolled. Participants received ten 60-min sessions of individual robotic gait training targeting paretic propulsion (five weeks, twice a week), complemented with home exercises (15 min/day) focusing on increasing strength and practicing learned strategies in daily life. Propulsion measures, gait kinematics and kinetics, self-selected gait speed, performance of functional gait tasks, and daily-life mobility and physical activity were assessed five weeks (T0) and one week (T1) before the start of intervention, and one week (T2) and five weeks (T3) after the intervention period. Results Between T0 and T1, no significant differences in outcomes were observed, except for a marginal increase in gait speed (+ 2.9%). Following the intervention, propulsion symmetry (+ 7.9%) and paretic propulsive impulse had significantly improved (+ 8.1%), whereas non-paretic propulsive impulse remained unchanged. Larger gains in propulsion symmetry were associated with more asymmetrical propulsion at T0. In addition, following the intervention significantly greater paretic trailing limb angles (+ 6.6%) and ankle plantarflexion moments (+ 7.1%) were observed. Furthermore, gait speed (+ 7.2%), 6-Minute Walk Test (+ 6.4%), Functional Gait Assessment (+ 6.5%), and daily-life walking intensity (+ 6.9%) had increased following the intervention. At five-week follow-up (T3), gains in all outcomes were retained, and gait speed had further increased (+ 3.6%). Conclusions The post-intervention gain in paretic propulsion did not only translate into improved propulsion symmetry and gait speed, but also pertained to performance of functional gait tasks and daily-life walking activity levels. These findings suggest that well-selected chronic stroke survivors may benefit from task-specific targeted training to utilize the residual propulsive capacity of the paretic leg. Future research is recommended to establish simple baseline measures for identification of individuals who may benefit from such training and confirm benefits of the used training concepts in a randomized controlled trial. Trial registration: Registry number ClinicalTrials.gov (www.clinicaltrials.gov): NCT04650802, retrospectively registered 3 December 2020.

Trajectories of stroke recovery of impairment, function, and quality of life in response to 12-month mobility and fitness intervention

2021 ◽  
pp. 1-12
Author(s):  
Catherine Boissoneault ◽  
Dorian K. Rose ◽  
Tyler Grimes ◽  
Michael F. Waters ◽  
Anna Khanna ◽  
...  
Keyword(s):  
Functional Disability ◽  
Functional Mobility ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Significant Group ◽  
Long Duration ◽  
Treatment Support ◽  
Clinically Significant ◽  
And Function

BACKGROUND: Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. OBJECTIVE: We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. METHODS: The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. RESULTS: We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. CONCLUSIONS: Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.

scholarly journals Motor Deficits in the Ipsilesional Arm of Severely Paretic Stroke Survivors Correlate With Functional Independence in Left, but Not Right Hemisphere Damage

2020 ◽  
Vol 14 ◽  
Author(s):  
Shanie A. L. Jayasinghe ◽  
David Good ◽  
David A. Wagstaff ◽  
Carolee Winstein ◽  
Robert L. Sainburg
Keyword(s):  
Motor Control ◽  
Grip Strength ◽  
Left Hemisphere ◽  
Motor Performance ◽  
Right Hemisphere ◽  
Functional Independence ◽  
Chronic Stroke ◽  
Motor Deficits ◽  
Stroke Survivors ◽  
Right Hemisphere Damage

Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary with hemisphere of damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage (10 left-, 10 right-hemisphere damaged individuals) to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of contralesional, paretic arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment (UEFM). Ipsilesional arm motor performance was evaluated using the Jebsen-Taylor Hand Function Test (JTHFT), grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [r(10) = −0.73, p = 0.017]; grip strength: [r(10) = 0.64, p = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [r(10) = 0.66, p = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors.

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

2020 ◽  
Author(s):  
Christopher P Mackay ◽  
Sandra G Brauer ◽  
Suzanne S Kuys ◽  
Mia A Schaumberg ◽  
Li-Ann Leow
Keyword(s):  
Motor Learning ◽  
Aerobic Exercise ◽  
Exercise Intervention ◽  
Functional Independence ◽  
Chronic Stroke ◽  
Sensorimotor Adaptation ◽  
Stroke Survivors ◽  
Positive Effects ◽  
Before And After ◽  
The University

AbstractSensorimotor 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.PurposeThe aim of this study was to determine whether acute aerobic exercise promotes sensorimotor adaptation in people post stroke.MethodsA single-blinded crossover study. Participants attended two separate sessions at the university campus, 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. Participants were twenty people with chronic stroke. Intervention completed was treadmill exercise at mod-high intensity for 30 minutes.ResultsResults demonstrated that acute aerobic exercise in chronic stroke survivors significantly increased sensorimotor adaptation from pre to post treadmill intervention.ConclusionThese results indicate a potential role for aerobic exercise to promote the recovery of sensorimotor function in chronic stroke survivors.

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