Cortical Reorganization Induced by Body Weight-Supported Treadmill Training in Patients With Hemiparesis of Different Stroke Durations

Yang Y-R, Chen I-H, Liao K-K, Huang C-C, Wang R-Y. Cortical reorganization induced by body weight-supported treadmill training in patients with hemiparesis of different stroke durations.

Objective

To investigate corticomotor changes induced by body weight-supported treadmill training (BWSTT) in patients with short or long poststroke duration.

Design

Single-blinded and randomized controlled trial.

Setting

Neurologic physical therapy research laboratory.

Participants

Hemiparesis patients (N=18) whose motor-evoked potentials could be induced participated in this study. Subjects in each hemiparesis postonset of short (<6mo) or long (>12mo) duration group were randomly assigned to either the control or experimental group.

Interventions

Subjects in the experimental groups participated in BWSTT for 4 weeks. Those in the control groups received the general exercise program.

Main Outcome Measures

The primary outcomes were motor threshold and map size of the abductor hallucis muscle in the ipsilesional hemisphere. The secondary outcome was Fugl-Meyer Assessment. Outcome measures were blindly assessed before and after completing the 4 weeks of training.

Results

The 4-week BWSTT resulted in a decrease of motor threshold and an increase of map size in subjects with hemiparesis of short duration, whereas only the expansion of the map size was noted in subjects with hemiparesis of long duration. Improvement of motor control occurred in subjects with hemiparesis of both short and long duration after BWSTT.

Conclusions

The BWSTT results in similar improvement in motor control but different patterns of treatment-induced cortical reorganization in subjects with different poststroke durations.     

Home-Based Treadmill Training to Improve Gait Performance in Persons With a Chronic Transfemoral Amputation

Objective

To investigate the effectiveness of a home-based multiple-speed treadmill training program to improve gait performance in persons with a transfemoral amputation (TFA).

Design

Repeated measures.

Setting

Research laboratory.

Participants

Individuals with a TFA (N=8) who had undergone a unilateral amputation at least 3 years prior as a result of limb trauma or cancer.

Intervention

Home-based treadmill walking for a total of 30 minutes a day, 3 days per week for 8 weeks. Each 30-minute training session involved 5 cycles of walking for 2 minutes at 3 speeds.

Main Outcome Measures

Participants were tested pretraining and after 4 and 8 weeks of training. The primary measures were temporal-spatial gait performance (symmetry ratios for stance phase duration and step length), physiological gait performance (energy expenditure and energy cost), and functional gait performance (self-selected walking speed [SSWS], maximum walking speed [MWS], and 2-minute walk test [2MWT]).

Results

Eight weeks of home-based training improved temporal-spatial gait symmetry at SSWS but not at MWS. A relative interlimb increase in stance duration for the prosthetic limb and proportionally greater increases in step length for the limb taking shorter steps produced the improved symmetry. The training effect was significant for the step length symmetry ratio within the first 4 weeks of the program. Energy expenditure decreased progressively during the training with nearly 10% improvement observed across the range of walking speeds. SSWS, MWS, and 2MWT all increased by 16% to 20%.

Conclusions

Home-based treadmill walking is an effective method to improve gait performance in persons with TFA. The results support the application of training interventions beyond the initial rehabilitation phase, even in individuals considered highly functional.     

Gravity-Supported Exercise With Computer Gaming Improves Arm Function in Chronic Stroke

Objective

To investigate the effect of 4 to 6 weeks of exergaming with a computer mouse embedded within an arm skate on upper limb function in survivors of chronic stroke.

Design

Intervention study with a 4-week postintervention follow-up.

Setting

In home.

Participants

Survivors (N=13) of chronic (≥6mo) stroke with hemiparesis of the upper limb with stable baseline Fugl-Meyer assessment scores received the intervention. One participant withdrew, and 2 participants were not reassessed at the 4-week follow-up. No participants withdrew as a result of adverse effects.

Intervention

Four to 6 weeks of exergaming using the arm skate where participants received either 9 (n=5) or 16 (n=7) hours of game play.

Main Outcome Measure

Upper limb component of the Fugl-Meyer assessment.

Results

There was an average increase in the Fugl-Meyer upper limb assessment score from the beginning to end of the intervention of 4.9 points. At the end of the 4-week period after the intervention, the increase was 4.4 points.

Conclusions

A 4- to 6-week intervention using the arm skate significantly improved arm function in survivors of chronic stroke by an average of 4.9 Fugl-Meyer upper limb assessment points. This research shows that a larger-scale randomized trial of this device is warranted and highlights the potential value of using virtual reality technology (eg, computer games) in a rehabilitation setting.     

Standardizing Communications Improves Use of Palliative Care in Patients With Stroke

Patients who have sustained a severe stroke have immediate palliative care needs, and poor communication is a gap in quality that increases length of stay (LOS) and costs, which decreases efficient resource utilization. To standardize communication between families and treatment teams in the intensive care unit (ICU) and demonstrate improvement in LOS and costs, a communication bundle was prospectively implemented in 22 patients and compared against a retrospective control arm of 22 patients. The intervention group demonstrated significant improvement in median ICU and hospital LOS and ICU costs. Standardizing communication significantly improved resource utilization in severe stroke patients.     

The Bucket Test Improves Detection of Stroke in Patients With Acute Dizziness

BackgroundIt is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes.ObjectivesWe evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness.MethodsIn this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient.ResultsSeventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59–100%). The specificity of the BT was 38% (95% CI 24–52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15–21%).ConclusionsThe BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.     

水中平板运动对脑卒中后偏瘫患者平衡功能的影响和机制研究

目的：研究水中平板运动对亚急性期偏瘫患者平衡功能的影响及其机制。方法：选取首次发病的偏瘫患者34例,分为观察组17例接受水中平板运动及陆上运动训练,对照组17例接受陆上运动训练;选取13例健康青年男性作为健康参照组。研究开始前、4周后,测量2组患者的Berg平衡量表（BBS）评分,两侧腹横肌厚度,患侧下肢股直肌、胫前肌和腓肠肌厚度,计算两侧腹横肌厚度比及患侧下肢主要抗重力肌群增厚比。腹横肌厚度、BBS评分等计量资料进行参数检验,腹横肌厚度比、下肢主要抗重力肌群增厚比等比值资料进行非参数检验,BBS评分与下肢抗重力肌群增厚比进行非参数相关性分析。结果：治疗4周后,2组两侧腹横肌厚度及BBS评分均较治疗前显著提高(均P<0.01);观察组患侧腹横肌厚度较对照组显著提高(P<0.05)。治疗前,2组患者腹横肌厚度比均低于健康组(均P＜0.05) 。治疗后,2组患者及健康组3组间均差异无统计学意义,观察组患者患侧下肢主要肌群增厚比较对照组有显著提高(均P<0.05),观察组下肢股直肌增厚比与胫前肌、外侧腓肠肌增厚比呈负相关(P＜0.05) ,胫前肌与外侧腓肠肌增厚比呈正相关(P＜0.05),2组患者BBS评分与各下肢肌群增厚比无显著相关性。结论：水中平板运动和陆上运动训练均可以提高偏瘫患者的平衡功能,水中平板运动可以有效提高患侧腹横肌厚度,改善异常的腹横肌形态,增强下肢主要抗重力肌群力量,改善步态。     

Effects of Treadmill Training on Limb Motor Function and Acetylcholinesterase Activity in Rats with Stroke

[Purpose] In the present study, we investigated the effects of treadmill training on limb motor function and acetylcholinesterase activity following focal cerebral ischemia injury. [Methods] Focal cerebral ischemia was examined in adult male Sprague-Dawley rats by using a middle cerebral artery occlusion model. Rats were randomly divided into 3 groups. Group I included untreated normal rats (n=12), Group II included untreated rats with focal cerebral ischemia (n=12), and Group III included rats that performed treadmill exercise (20 m/min) training after focal cerebral ischemia (n=12). We determined the limb placement test score for each rat on days 1,7, 14, and 21; acetylcholinesterase activity in the hippocampus was examined at the end of the experiment. [Results] We observed that the motor behavior index improved in the treadmill group, and hippocampal acetylcholinesterase activity was decreased. [Conclusion] These results indicated that treadmill training after focal cerebral ischemia exerts a neuroprotective effects against ischemic brain injury by improving motor performance and decreasing the levels of acetylcholinesterase activity. Furthermore, these results suggest that treadmill training at an appropriate intensity is critical for post-stroke rehabilitation.Key words: Acetylcholinesterase, Stroke, Treadmill exercise     

Association of Objectively Measured Timing of Physical Activity Bouts With Cardiovascular Health in Type 2 Diabetes

OBJECTIVEModerate- to vigorous-intensity physical activity (MVPA) improves cardiovascular health. Few studies have examined MVPA timing. We examined the associations of timing of bout-related MVPA with cardiorespiratory fitness and cardiovascular risk in adults with type 2 diabetes.RESEARCH DESIGN AND METHODSBaseline 7-day hip-worn accelerometry data from Look AHEAD participants (n = 2,153, 57% women) were analyzed to identify bout-related MVPA (≥3 METs/min for ≥10 min). Cardiorespiratory fitness was assessed by maximal graded exercise test. Participants were categorized into six groups on the basis of the time of day with the majority of bout-related MVPA (METs × min): ≥50% of bout-related MVPA during the same time window (morning, midday, afternoon, or evening), <50% of bout-related MVPA in any time category (mixed; the reference group), and ≤1 day with bout-related MVPA per week (inactive).RESULTSCardiorespiratory fitness was highly associated with timing of bout-related MVPA (P = 0.0005), independent of weekly bout-related MVPA volume and intensity. Importantly, this association varied by sex (P = 0.02). In men, the midday group had the lowest fitness (β = −0.46 [95% CI −0.87, −0.06]), while the mixed group in women was the least fit. Framingham risk score (FRS) was associated with timing of bout-related MVPA (P = 0.02), which also differed by sex (P = 0.0007). The male morning group had the highest 4-year FRS (2.18% [0.70, 3.65]), but no association was observed in women.CONCLUSIONSTiming of bout-related MVPA is associated with cardiorespiratory fitness and cardiovascular risk in men with type 2 diabetes, independent of bout-related MVPA volume and intensity. Prospective studies are needed to determine the impacts of MVPA timing on cardiovascular health.     

水中平板训练和减重平板训练对脑卒中偏瘫患者步行和平衡功能的影响

目的比较水中平板训练(UWTT)、减重平板训练(BWSTT)和常规步行训练(CGT)对脑卒中偏瘫患者步行和平衡功能的效果。方法 43例脑卒中偏瘫患者分为CGT组(n=14)、BWSTT组(n=13)和UWTT组(n=16),后两组在CGT组的基础上,分别接受BWSTT和UWTT。训练前后采用功能性步行分级(FAC)、10 m最大步行速度(MWS)、6 min步行距离(6MWT)进行评定,采用平衡测试仪进行动、静态平衡功能测试。结果经过4周训练,各组FAC、MWS、6MWT及动、静态平衡功能指标均有改善(P0.05);UWTT组在6MWT、患侧下肢负重时间、闭眼重心移动总轨迹长及稳定极限范围方面优于BWSTT组(P0.05)。结论UWTT在改善患者步行耐力及动、静态平衡功能等方面效果优于BWSTT。     

减重支持系统对脑卒中偏瘫患者行走能力的影响

目的：探讨减重支持系统训练（PBWS）对脑卒中患者行走能力的影响。方法：53例脑卒中患者随机分为对照组27例和PBWS组26例，均进行常规的功能训练；PBWS组配合减重支持系统训练。结果：治疗8周后2组患者的Berg平衡量表评分、Fugl—Meyer下肢运动功能评分、ADL评分及10rn步行速度与治疗前比较均有明显提高（P〈0．05-0．01），其中Fugl—Meyer评分2组比较差异无显著性意义，其他各项指标评分PBWS组均明显高于对照组（P〈0．05）。结论：功能训练可改善脑卒中患者整体运动功能，结合PBWS更能明显提高治疗效果。     

Unilateral Strength Training of the Less Affected Hand Improves Cortical Excitability and Clinical Outcomes in Patients With Subacute Stroke: A Randomized Controlled Trial

ObjectivesTo investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke.DesignRandomized controlled trial.SettingRehabilitation sciences research center.ParticipantsPatients with subacute stroke (N=26) were randomly assigned to a control group (n=13) or the experimental group (n=13).InterventionsParticipants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions, 3 d/wk).Main Outcome MeasuresCortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP), and cortical silent period (CSP) at baseline and after the 4-week intervention period. Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADL), and spasticity.ResultsThe experimental group showed greater MEP amplitude (P=.001) in the ipsiH and shorter CSP duration in both the ipsiH (P=.042) and contraH (P=.038) compared with the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (P=.029) and less affected (P=.001) hand, upper extremity motor function (P=.04), and spasticity (P=.014) were greater in the experimental group. No significant difference in ADLs was detected between groups.ConclusionsA combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.     

Exergaming With Additional Postural Demands Improves Balance and Gait in Patients With Multiple Sclerosis as Much as Conventional Balance Training and Leads to High Adherence to Home-Based Balance Training

Objective

To assess the effectiveness of and adherence to an exergame balance training program with additional postural demands in patients with multiple sclerosis (MS).

Design

Matched controlled trial, assessment of balance before and after different balance training programs, and adherence to home-based balance exercise in the 6 months after the training.

Setting

A neurorehabilitation facility and center for MS.

Participants

Patients with balance problems (N=70) matched into 1 of the training groups according to age as well as balance and gait performance in 4 tests. Nine patients dropped out of the study because of scheduling problems. The mean age of the 61 remaining participants was 47±9 years, and their Expanded Disability Status Scale score was 3±1.

Interventions

Three weeks of (1) conventional balance training (control), (2) exergame training (playing exergames on an unstable platform), or (3) single-task (ST) exercises on the unstable platform.

Main Outcome Measures

Test scores in balance tests and gait analyses under ST and dual-task (DT) situations. Furthermore, in the 6 months after the rehabilitation training, the frequency and type of balance training were assessed by using questionnaires.

Results

All 3 groups showed significantly improved balance and gait scores. Only the exergame training group showed significantly higher improvements in the DT condition of the gait test than in the ST condition. Adherence to home-based balance training differed significantly between groups (highest adherence in the exergame training group).

Conclusions

Playing exergames on an unstable surface seems to be an effective way to improve balance and gait in patients with MS, especially in DT situations. The integration of exergames seems to have a positive effect on adherence and is thus potentially beneficial for the long-term effectiveness of rehabilitation programs.     

Sarcopenic Obesity: Prevalence and Association With Metabolic Syndrome in the Korean Longitudinal Study on Health and Aging (KLoSHA)

OBJECTIVE

We investigated the prevalence of sarcopenic obesity (SO) and its relationship with metabolic syndrome in a community-based elderly cohort in Korea.

RESEARCH DESIGN AND METHODS

In this study, 287 men and 278 women aged 65 or older were recruited. Sarcopenia was defined as the appendicular skeletal muscle mass (ASM) divided by height squared (Ht²) (kg/m²) or by weight (Wt) (%) of <1 SD below the sex-specific mean for young adults. Obesity was defined as a visceral fat area ≥100 cm².

RESULTS

The prevalence of SO was 16.7% in men and 5.7% in women with sarcopenia defined by ASM/Ht²; however, it was 35.1% in men and 48.1% in women by ASM/Wt. Using ASM/Wt, the homeostasis model assessment of insulin resistance of subjects with SO was higher and they were at higher risk for metabolic syndrome (odds ratio [OR] 8.28 [95% CI 4.45–15.40]) than the obese (5.51 [2.81–10.80]) or sarcopenic group (2.64 [1.08–6.44]).

CONCLUSIONS

SO defined by ASM/Wt was more closely associated with metabolic syndrome than either sarcopenia or obesity alone.The number of obese elderly people is increasing worldwide. Aging is associated with increased fat mass and reduced muscle mass or strength, even in those with stable body weight. This sarcopenic obesity (SO) is associated with deteriorations in physical disability, morbidity, and mortality. Therefore, sarcopenia and obesity might act synergistically on metabolic and functional impairments in the elderly (1–2). However, there have been few reports investigating the association of SO with metabolic syndrome, particularly in Asian ethnic groups. The aim of the present study was to investigate the prevalence of SO and its association with metabolic syndrome in a community-based elderly cohort in Korea.     

Identifying Key Physical Activity Categories and Topics to Include in Health Professional Training Programs

Abstract

Phenomenon: Healthcare is an important sector in promoting physical activity (PA). However, few health professional training programs include PA, nor does standardized guidance exist on implementing it in the curriculum. This study aimed to consolidate health professional expert opinion on key PA categories and topics that should be included in the curriculum of health professional training programs. Approach: A three-round, modified e-Delphi process examined the opinions of 73 experts from seven health professions (clinical nutrition, exercise physiology, medicine, nursing, occupational therapy, physical therapy, physician assistants). In Round 1, panelists reported importance, ranked, and scored five broad PA categories, and responded to open-ended prompts for additional categories. In Round 2, panelists received summary feedback, re-ranked and re-scored PA categories, and suggested key PA topics within the five categories. In the final round, panelists viewed, ranked, and scored the PA topics. Findings: Expert panelists felt that all PA categories were important, with Health Behavior Change ranking the highest (98.7%) followed by Cellular and Systemic Implications of Exercise, Clinical Exercise Physiology, and PA and Public Health. The Administrative Aspects of Integrating PA into Health Systems ranked least important (48.0%). A consensus on the key PA categories was considered reached after two rounds. Five to eight specific PA topics were generated within each PA category and ranked in order of importance. Insights: These findings highlight several key PA categories and topics that can serve as a foundation for a diverse number of health professional training programs.     

Tai Chi Improves Oxidative Stress Response and DNA Damage/Repair in Young Sedentary Females

[Purpose] This study was to examine the effects of 12 weeks of Tai Chi (TC) exercise on antioxidant capacity, and DNA damage/repair in young females who did not perform regular physical exercise. [Subjects and Methods] Ten female students from a Chinese university voluntarily participated in this program. All of them practiced the 24-form simplified Tai Chi, 5 times weekly, for 12 weeks. Plasma levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA), glutathione (GSH), hydroxyl radical inhibiting capacity (OH·-IC), 8-hydroxy-2’-deoxyguanosine (8-OHdG), and 8-oxoguanine DNA glycosylase (OGG1) were measured at 0, 8, and 12 weeks. Heart rate (HR) was monitored during the last set of the training session at 4, 8, and 12 weeks. [Results] Plasma SOD and OH·-IC levels were increased at 8 and 12 weeks compared to the baseline (0 weeks). Gpx and GSH levels did not change significantly throughout the study period. The plasma MDA level was decreased significantly at 8 weeks but not at 12 weeks compared to the baseline value. While the plasma 8-OHdG level did not change throughout the study period, the plasma OGG1 level was significantly increased at 8 and 12 weeks compared to the baseline value. [Conclusion] TC practice for 12 weeks efficiently improved the oxidative stress response in young females who did not perform regular physical exercise. The TC exercise also increased the DNA repairing capacity.Key words: Tai Chi, Oxidative stress, DNA damage     

Spinal Manipulation Therapy Improves Tactile Allodynia and Peripheral Nerve Functionality and Modulates Blood Oxidative Stress Markers in Rats Exposed to Knee-Joint Immobilization

ObjectiveThe purpose of our study was to evaluate the effect of manually assisted lumbar spinal manipulation therapy on tactile allodynia, peripheral nerve functional recovery, and oxidative markers in rats exposed to knee immobilization-inducing hypersensitivity.MethodsTactile allodynia and sciatic, tibial, and peroneal functional indices were assessed before the knee joint immobilization, 24 hours after the knee cast removal, and 24 hours after 3 weeks of lumbar therapy with the Activator Adjusting Instrument, model 4 (AAI 4). Subsequently, the blood was collected from each rat, and oxidative markers such as lipid hydroperoxide levels; nitric oxide metabolites; and superoxide dismutase, catalase, and glutathione peroxidase activities were assessed.ResultsThe AAI 4 improved the immobilization-induced allodynia and recovered the peripheral nerve functional indices impaired after knee immobilization. Immobilized rats treated with AAI 4 therapy presented a lack of significant changes in lipid hydroperoxides and nitric oxide metabolites in the plasma contrasting with rats that were kept freely in their cages, with no therapy applied, which presented elevated lipid hydroperoxides levels. Also, the antioxidant catalase enzymatic activity decreased in the blood of rats immobilized and treated with AAI 4.ConclusionThese results suggest that manually assisted lumbar spinal manipulation therapy modulates systemic oxidative stress, which possibly contributes to the analgesia and recovery of peripheral nerve functionality.     

The Affective Dimension of Dyspnea Improves in a Dyspnea Self-Management Program With Exercise Training

ContextThe perception of dyspnea includes both sensory and affective dimensions that are shaped by emotions and psychological, social, and environmental experiences. Previous investigators have studied either measurement or strategies to decrease the affective dimension with laboratory-induced dyspnea. Few have reported the effect of a therapeutic clinical intervention on the affective dimension of dyspnea.Objectives1) To evaluate the effects of three different versions of a dyspnea self-management program (DM) on the affective dimension of dyspnea, measured by dyspnea-related anxiety (DA) and dyspnea-related distress (DD); and 2) to determine the stability of DA and DD over two baseline incremental treadmill tests (ITTs).MethodsParticipants with chronic obstructive pulmonary disease were randomly assigned to three 12 month DMs with varying doses of supervised exercise (DM, DM-Exposure, and DM-Training). The measurements of the affective dimension, DA and DD, were rated during ITTs on two baseline days and at two, six, and 12 months. Changes over time in DA and DD were analyzed using linear mixed-effects models.ResultsParticipants in the DM-Training group who received 24 nurse-coached exercise sessions had significantly greater reductions in DA and DD compared with those who had four exercise sessions (DM-Exposure) or only received a home-walking program (DM). Reductions in DA and DD in the DM-Training group were only maintained through six months. There were no significant differences in ratings of DA and DD at end between the two baseline ITTs.ConclusionThese findings provide initial support for the positive impact of a self-management program with nurse-coached exercise on the affective dimension of dyspnea. Further investigation of interventions that target the affective dimension in addition to the sensory dimension of dyspnea should be encouraged.