Non-paretic lower limb muscle wasting during acute phase is associated with dependent ambulation in patients with stroke

BackgroundMuscle wasting in patients with stroke is a factor for a poor functional outcome. However, there have been few studies on the relationships between lower limb muscle wasting during the acute phase and dependent ambulation. This study examined whether lower limb muscle wasting during the acute phase is associated with the dependent ambulation status at 3 months after stroke.MethodsIn this observational cohort study, we measured the quadriceps muscle thickness in the paretic and non-paretic limbs within 1 and 3 weeks after admission using ultrasonography in non-ambulatory patients with acute stroke. Patients were categorized into two groups based on their ambulation ability: dependent, functional ambulation category (FAC) 0–3 and independent, FAC 4–5) at 3 months after stroke.ResultsIn total, 55 patients were included and completed follow-up, and 28 patients (51%) had an ambulation status of dependent at 3 months after stroke. Significant differences in muscle wasting were observed in the non-paretic limb (−5.5% [8.7%] : −16.8% [13.6%], independent group: dependent group, respectively, P < 0.001), but not in the paretic limb (−15.0% [14.3%] : −18.7% [15.1%], P = 0.36). Even after adjusting for covariates, muscle wasting in the non-paretic limb was a significant independent predictor of dependent ambulation (adjusted odds ratio, 0.87; 95% confidence interval, 0.76–0.99, P = 0.033).ConclusionPost-stroke muscle wasting in the non-paretic lower limb during the acute phase is independently associated with dependent ambulation after stroke.     

Peripheral motor nerve conduction abnormality,muscle strength,and muscle wasting in patients with acute stroke: A pilot study

IntroductionStroke-related muscle wasting are important therapeutic targets to reduce disability in patients with stroke. Peripheral nerve conduction impairment is one reported factor that causes muscle wasting in these patients, but muscle strength, muscle wasting, and peripheral nerve conduction abnormality have not been examined in patients with acute stroke. We therefore investigated changes in lower-leg motor nerve conduction, muscle strength, and muscle wasting in patients with acute stroke.MethodsPatients with acute stroke were recruited. Their motor conduction velocity (MCV) and compound motor action potential (CMAP) amplitude in both sides of the common peroneal nerve, and lower paretic leg muscle strength by the Motricity Index (MI) and quadriceps muscle thickness (QMT) on both sides were measured at the time of admission and again 2 weeks later.ResultsEighteen patients with acute stroke (median [interquartile range], age = 68 [14] years; female = 4 [22%]) were enrolled. The MCV and CMAP amplitude were not significantly different between limbs. The QMT was significantly reduced in paretic (P = 0.014) and non-paretic (P = 0.003) limbs, but the lower paretic leg MI was increased (P = 0.0.001). There was a significant correlation between % differences in CMAP amplitude and % differences in QMT in the paretic limb (R = 0.604, P = 0.008), but not in the non-paretic limb (R = 0.225, P = 0.369).ConclusionsLower-leg muscle wasting was associated with the change in CMAP amplitude in paretic limbs, but not in non-paretic limbs, in patients with acute stroke.     

Effects of constraint-induced movement therapy for lower limbs on measurements of functional mobility and postural balance in subjects with stroke: a randomized controlled trial*

Background: Constraint-induced movement therapy (CIMT) is suggested to reduce functional asymmetry between the upper limbs after stroke. However, there are few studies about CIMT for lower limbs.

Objective: To examine the effects of CIMT for lower limbs on functional mobility and postural balance in subjects with stroke.

Methods: A 40-day follow-up, single-blind randomized controlled trial was performed with 38 subacute stroke patients (mean of 4.5 months post-stroke). Participants were randomized into: treadmill training with load to restraint the non-paretic ankle (experimental group) or treadmill training without load (control group). Both groups performing daily training for two consecutive weeks (nine sessions) and performed home-based exercises during this period. As outcome measures, postural balance (Berg Balance Scale – BBS) and functional mobility (Timed Up and Go test – TUG and kinematic parameters of turning – Qualisys System of movement analysis) were obtained at baseline, mid-training, post-training and follow-up.

Results: Repeated-measures ANOVA showed improvements after training in postural balance (BBS: F = 39.39, P < .001) and functional mobility, showed by TUG (F = 18.33, P < .001) and by kinematic turning parameters (turn speed: F = 35.13, P < .001; stride length: F = 29.71, P < .001; stride time: F = 13.42, P < .001). All these improvements were observed in both groups and maintained in follow-up.

Conclusions: These results suggest that two weeks of treadmill gait training associated to home-based exercises can be effective to improve postural balance and functional mobility in subacute stroke patients. However, the load addition was not a differential factor in intervention.     

Muscle Oxygenation of the Paretic and Nonparetic Legs During and After Arterial Occlusion in Chronic Stroke

Oxygen delivery and demand are reduced in the paretic leg post-stroke, reflecting decreased vascular function and reduced muscle quantity and quality. However, it is unknown how muscle oxygenation, the balance between muscle oxygen delivery and utilization, is altered in chronic stroke during and after occlusion-induced ischemia.ObjectivesThe objective was to determine muscle oxygen consumption rate, microvascular responsiveness and reactive hyperemia in the paretic and nonparetic legs during and after arterial occlusion post-stroke.Materials and MethodsMuscle oxygen saturation was measured with near-infrared spectroscopy on the vastus lateralis of each leg during 3-minute arterial occlusion and recovery (3 min). Muscle oxygen consumption was derived from the desaturation slope during ischemia, microvascular responsiveness was derived from the resaturation slope after ischemia and reactive hyperemia was derived from the area under the curve above baseline after ischemia. Results: Eleven subjects (91% male; 32.2±6.1 months post-stroke; age 62.9±13.6 years) with a hemiparetic gait pattern participated. There was no significant between-leg muscle oxygenation difference at rest (paretic: 64.9±16.6%; nonparetic: 70.6±15.6%, p = 0.13). Muscle oxygen consumption in the paretic leg (-0.53±0.24%/s) was significantly reduced compared to the nonparetic leg (-0.70±0.36%/s; p = 0.03). Microvascular responsiveness was significantly reduced in the paretic leg compared to the nonparetic leg (paretic: 4.6±1.8%/s; nonparetic: 5.7±1.6%/s, p = 0.04). Reactive hyperemia was not significantly different between legs (paretic:4384±2341%·s; nonparetic: 3040±2216%·s, p = 0.07).ConclusionMuscle oxygen consumption and microvascular responsiveness are impaired in the paretic compared to the nonparetic leg, suggesting both reduced skeletal muscle aerobic function and reduced ability to maximally perfuse muscle tissue.     

Dance-based exergaming for upper extremity rehabilitation and reducing fall-risk in community-dwelling individuals with chronic stroke. A preliminary study

Background: Post-stroke, individuals demonstrate persistent upper extremity (UE) motor impairments that impact functional movements and change-in-support strategies essential for recovery from postural instability. OBJECTIVES: This study primarily aims to quantify the effect of dance-based exergaming (DBExG) intervention on improving paretic UE movement control. The secondary aim is to assess if these improvements in UE movement control if observed, could partially account for improved fall-risk.

Methods: Thirteen adults with chronic stroke received DBExG training using the commercially available Kinect dance gaming “Just Dance 3”. Surface electromyography of shoulder muscle activity during the stand-reaching task and UE shoulder kinematics for a dance trial were recorded. Changes in balance control were determined using the Activities-specific Balance Confidence scale [ABC] and Timed-Up-and-Go test [TUG].

Results: Post-training, participants demonstrated improvements in shoulder muscle activity in the form of performance (reaction time, burst duration, and movement time) and production outcomes (peak acceleration) (p < .05). There was also a post-training increase in shoulder joint excursion (Ex) and peak joint angles (∠) during dance trials (p < .05). Participants exhibited positive post-intervention correlations between ABC and shoulder joint Ex [R² of 0.43 (p < .05)] and between TUG and peak joint ∠ [R² of 0.51 (p < .05)]. CONCLUSION: Findings demonstrated the beneficial effect of DBExG for improving UE movement and the training-induced gains were also positively correlated with improvements in fall-risk measures in people with chronic stroke. Thus, DBEx training could be used as a meaningful clinical application for this population group.     

The effect of isolating the paretic limb on weight-bearing distribution and EMG activity during squats in hemiplegic and healthy individuals

Background: Neural reorganization for movement therapy after a stroke is thought to be an important mechanism that facilitates motor recovery. However, there is a lack of evidence for the effectiveness of exercise programs in improving the lower limbs.

Objective: We investigated the immediate effect of isolating the paretic limb using different foot positions ((i) foot parallel; both feet parallel, (ii) foot asymmetry; paretic foot backward by 10 cm, and (iii) foot lifting; nonparetic foot lifting by normalization to 25% of knee height) on weight-bearing distribution and electromyography (EMG) of the thigh muscle during squats.

Methods: In total, 20 patients with hemiplegia and 16 healthy subjects randomly performed three squat conditions in which the knee joint was flexed to 30°. Weight distribution was measured using the BioRescue system. Muscle activity was measured using a surface EMG system.

Results: Patients with hemiplegia exhibited significantly decreased weight bearing on the paretic foot at 0° and 30° knee flexion compared with the nondominant foot of a healthy subject. The muscle activity of the quadriceps was significantly lower in patients with hemiplegia compared to healthy subjects. Weight bearing and EMG activity of the quadriceps femoris on the paretic or nondominant side significantly increased during a knee flexion of 30° with under the foot asymmetry and foot lifting positions compared with the parallel foot position.

Conclusion: Isolating the paretic limb using the asymmetric foot positions and lifting of the foot during squats might help patients with hemiplegia to improve weight-bearing and achieve greater activation of the quadriceps muscle in the paretic limb.     

Dry eye in chronic stroke patients with hemiplegia: A cross-sectional study

ABSTRACT

Objective: Dry eye is reported to be associated with several neurological diseases. The aim of this study is to evaluate the patients with hemiplegia after stroke for dry eye and compare their results with a control group.

Materials and methods: Forty-five patients with hemiplegia and 45 individuals as the control group were included in the study. Tear function tests (Schirmer and tear breakup time) and a dry eye questionnaire for dry eye symptoms (ocular surface disease index) were performed and the results of the two groups were compared.

Results: Schirmer test results were significantly lower in the post-stroke hemiplegia group compared to the control group (11.3 ± 8.2 mm and 20.6 ± 11.6 mm, respectively, p < .001). Tear breakup time results were significantly lower in the post-stroke hemiplegia group compared to the control group (7.9 ± 3.1 s and 12.1 ± 4.3 s, respectively, p < .001). Ocular surface disease index scores were not significantly different between hemiplegia and control groups (21.6 ± 20.0 and 19.8 ± 13.9, respectively, p = .635). Schirmer scores lower than 10 mm (60% and 30%, p < .001) and tear breakup time results lower than 10 s (65.6% and 28.9%, p < .001) were also higher in the hemiplegia group compared to control group.

Conclusion: We found lower Schirmer test and tear breakup time results and similar OSDI scores in hemiplegia patients compared to controls. Hemiplegia patients may have dry eye without typical symptoms. This should be taken into consideration in the follow-up and rehabilitation of post-stroke hemiplegia patients.     

Skeletal muscle changes following stroke: a systematic review and comparison to healthy individuals

Background: Despite extensive study of the impact of stroke on muscle and functional performance, questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production.

Objectives: To synthesize available evidence describing post-stroke changes in lower extremity muscle size and strength compared to healthy adults.

Methods: Scientific literature was searched up to April 2016 to identify studies that included lower extremity muscle size and strength measures in individuals with chronic stroke. Lower extremity muscle size and strength data from healthy controls were sought for comparison. Relative differences were calculated between paretic, nonparetic, and control limbs.

Results: Fifteen studies with 375 participants (61% male; age = 62 ± 5 years; time since stroke = 60 ± 42 months) were included. The paretic limb exhibited deficits of ~13% in thigh muscle size, ~5% in lower leg muscle size, and ~8% in lean leg mass compared to the nonparetic limb. Paretic plantarflexor and knee extensor strength were 52 and 36% lower, respectively, compared to the nonparetic limb. When compared to age-matched control data, both paretic and nonparetic limbs showed deficits in muscle size and strength.

Conclusions: Age-related differences support the impact of stroke-related sarcopenia as a contributor to hemiparetic muscle dysfunction. Understanding these muscular changes is necessary for designing appropriate exercise interventions aimed at restoring muscle function.     

The biomechanical investigation of the relationship between balance and muscular strength in people with chronic stroke: a pilot cross-sectional study

Background: Impaired balance and weak muscle strength are common deficits associated with stroke. Limited research has examined the relationship between balance and strength in people post-stroke.

Objective: To investigate the association between balance and muscular strength in people post-stroke.

Methods: A total of 11 people with chronic stroke, who were community dwelling and ambulatory, completed balance and strength assessments. A computerized dynamic posturography system was used for Limits of Stability (LOS) test, Sit-to-Stand (STS) test, and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Additionally, a computerized dynamometer was used to assess the isometric muscle strength of flexion/extension in the core (the trunk) and the leg (the hip, knee, and ankle). Pearson correlation analysis was used to investigate the relationship between balance and muscle strength measurements.

Results: Endpoint excursion (EPE) (r = .646; p < 0.032) and maximum excursion (MXE) (r = .613; p < 0.045) of LOS test were positively correlated with core and leg strength (C&L). Specifically, both EPE (r = ?.792; p < 0.004) and MXE (r = ?.623; p < 0.041) in backward direction had strong correlations with C&L. Core strength also showed a positive correlation with EPE of LOS test (r = .636; p < 0.035) while the composite leg strength did not. Lastly, STS and mCTSIB tests did not demonstrate significant associations with muscle strength.

Conclusions: The results indicate that the C&L have a strong relationship with the ability to shift body weight in multiple directions, particularly backward, among people post-stroke. However, static balance and STS performance do not appear to be related to muscle strength.     

Changes in Quadriceps Thickness and Echo Intensity in Chronic Stroke Survivors: A 3-Year Longitudinal Study

Objectives: The aim of the current study was to examine longitudinal changes in quadriceps muscle mass and intramuscular adipose tissue in chronic stroke survivors. Materials and Methods: In this longitudinal study included 34 chronic stroke survivors who lived in the community. Ultimately, 20 chronic stroke survivors received an after 3-year assessment. Fourteen chronic stroke survivors were lost at follow-up. Chronic stroke survivors who were followed and not followed during 3 years were categorized as follow-up group and lost follow-up group, respectively. The quadriceps muscle mass and intramuscular adipose tissue were assessed at baseline and after 3-year assessments based on muscle thickness and echo intensity in ultrasound images, respectively. Results: No significant differences in any characteristics were observed between the flow-up and lost follow-up groups. In the follow-up group, there was a significant decrease in quadriceps thickness on the paretic (10.3% decrease) and non-paretic (17.0% decrease) sides at follow-up after 3 years compared with baseline. There was a significant increase in quadriceps echo intensity on the paretic (20.0% increase) and non-paretic (24.9% increase) sides at follow-up after 3 years compared with baseline. There were significant positive relationships between changes in body weight and changes in quadriceps thickness on the paretic and non-paretic sides. Chronic stroke survivors with greater reductions in body weight showed a trend towards a greater decrease in quadriceps thickness on the paretic and non-paretic sides. Conclusions: The current results suggest marked longitudinal changes in the skeletal muscles in chronic stroke survivors. Preventing secondary changes in skeletal muscles and limiting decreases in body weight are essential for improving outcomes in chronic stroke survivors.     

The practice and predictors of early mobilization of patients post-acute admission to a specialized stroke center

Background: Early mobilization (EM) post-stroke is recommended; however, the ideal timing and nature of EM, and factors that may influence EM practice are unclear.

Objectives: The primary objective was to describe the type and extent of mobilization 0–48 h post-stroke admission to acute hospital care. A secondary objective was to evaluate whether pre-stroke functional level, stroke severity, tissue plasminogen activator (tPA) administration, and level of consciousness (LOC) predicted any passive, any active, and out-of-bed mobilization (i.e. sitting at edge-of-bed, standing, or ambulation) 0–24 h post-admission.

Methods: A quantitative, cross-sectional, retrospective review of health records of patients admitted to a specialized acute stroke center in 2016 was conducted.

Results: Data from 296 eligible health records were abstracted. Median age was 73 years, and 87% of patients had sustained an ischemic stroke. Active, passive, and out-of-bed mobilization occurred in 91.6%, 57.1%, and 24.3% of patients by 12 h post-admission, respectively, and 99.3%, 78.4%, and 77.4% of patients by 48 h post-admission, respectively. Administration of tPA, stroke severity, and impaired LOC, were each associated with any passive mobilization, and no tPA administration, stroke severity, and normal LOC were each associated with out-of-bed mobilization 0–24 h post-admission (p < 0.05).

Conclusions: Almost all patients receive active mobilization by 12 h post-admission whereas out-of-bed mobilization is infrequent. In the first 24 h post-admission, clinicians may prioritize passive over out-of-bed mobilization when patients have received tPA, present with severe stroke, and have impaired LOC. This conservative approach is unsurprising given the lack of clear practice recommendations for these situations.     

Intra- and inter-rater reliability of the 10-meter ambulation test in hemiparesis is better barefoot at maximal speed

Objectives Reliability of clinical tests to evaluate ambulation in chronic hemiparesis may vary according to the testing condition. The 10-meter ambulation test (AT10) assesses walking speed and step length over 10 m, starting and ending in seated position. In the present study, we compared the intra- and inter-reliability of AT10 in chronic hemiparesis in four different conditions: with shoes and barefoot, at free and maximal safe speed.

Methods Ten patients with hemiparesis, >1 year post-stroke (age 45 ± 12, time since stroke 16 ± 9 months, mean ± SD) participated in the reliability study (registration, ID-RCB-2017-A00090-53). All patients performed the AT10 twice, one week apart, in each of the four conditions. The number of steps and time to complete the task were manually recorded by four independent raters. The main outcome measurements were the intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean raw differences (DIFF) of the three parameters of AT10 (speed, step length, and cadence) in each of the four conditions. Effects of wearing shoes and speed condition were explored using ANOVA.

Results Across all conditions, mean intra- and inter-rater ICCs were, respectively, 98.5 ± 0.1 and 99.9 ± 0.1% for speed, 98.3 ± 0.1 and 99.7 ± 0.2% for step length, and 96.5 ± 0.1 and 98.9 ± 0.6% for cadence. Mean intra- and inter-rater CV for speed were 0.051 ± 0.016 and 0.022 ± 0.002, respectively. Intra-rater reliability of speed assessments was higher at maximal than at free speed (ICC, CV, DIFF, p < 0.05). At free speed, intra-rater ICCs were higher barefoot than with shoes (p < 0.05).

Discussion Performing the 10-meter ambulation test barefoot at maximal speed optimizes its reliability.     

Postural instability years after stroke

BackgroundFollowing a stroke, balance disturbances often persist despite full recovery of the paretic side.AimsThe aims were to determine how long postural instability could be detected after stroke and the differences in post-stroke patients under and above 65 years of age.MethodsStatic and dynamic posturography (passing weights from hand to hand around the body) measurements were performed on 29 patients with stroke after 3 ± 2.4 years (≤65 years) and 4.7 ± 3.3 years. (> 65 years) compared with 38 controls.ResultsOnly the pathway and the velocity assessed by dynamic posturography were significantly higher (p < 0.05) in the younger group of patients compared with the controls. The older group of patients had significantly elevated parameters measured by both static (p < 0.01) and dynamic posturography (p < 0.05).Conclusionswe conclude, using a sensitive and reproducible method to assess both static and dynamic adjustments to maintain balance, that postural instability is significantly greater in post-stroke patients than control subjects. This difference is demonstrable up to 4 years after stroke, despite full recovery of the affected side.     

Pilot randomized controlled trial to assess a physical therapy program on upper extremity function to counteract inactivity in chronic stroke

Background: In chronic stroke, feasible physical therapy (PT) programs are needed to promote function throughout life.

Objective: This randomized controlled pilot trial investigated the feasibility and effect of a PT program composed of strengthening exercises with elastic bands and bimanual functional training, with clearly defined doses based on the rate of perceived exertion (Borg scale), to counteract inactivity in chronic stroke.

Methods: Fifteen subjects > 6 month post-stroke were randomized to three-month of UE function training (UE group), or to lower extremity function training (LE group). At baseline (T0), post-intervention (T1) and three-month follow-up (T2) assessment included the Fugl-Meyer Assessment scale (FMA), Wolf Motor Function test (WMFT), grip strength, and muscle tone. Feasibility was also evaluated.

Results: The mixed-model ANOVAs revealed a significant interaction between the time and group factors for FMA (p < .001) and WMFT (p = .009). The UE group improved upper extremity function and motor recovery significantly more than the LE group. There was no significant interaction between treatment group and change in grip strength over time (p = .217). No between-group differences (p > .05) were found in muscle tone. In the UE group, the attendance rate was ≥85% for 71.4% of subjects and 85.7% showed high satisfaction. No adverse events were recorded. After treatment, adherence to the program was higher in the UE group.

Conclusions: The suggested PT program may be useful to improve the paretic UE function and motor recovery in chronic stroke. Moreover, it may be helpful to facilitate lifelong active involvement of stroke subjects in exercise.     

Home-based telesurveillance and rehabilitation after stroke: a real-life study

Background: After discharge from in-hospital rehabilitation, post-stroke patients should have the opportunity to continue the rehabilitation through structured programs to maintain the benefits acquired during intensive rehabilitation treatment.

Objective: The primary objective was to evaluate the feasibility of implementing an home-based telesurveillance and rehabilitation (HBTR) program to optimize the patient's recovery by reducing dependency degree.

Method: Post-stroke patients were consecutively screened. Data were expressed as mean ± standard deviation (SD). 26 patients enrolled: 15 were sub-acute (time since stroke: 112?±?39?days) and 11 were chronic (time since stroke: 470?±?145?days). For 3?months patients were followed at home by a nurse-tutor, who provided structured phone support and vital signs telemonitoring, and by a physiotherapist (PT) who monitored rehabilitation sessions by videoconferencing.

Results: 23 patients completed the program; 16.7?±?5.2 phone contacts/patient were initiated by the nurse and 0.9?±?1.8 by the patients. Eight episodes of atrial fibrillation that required a change in therapy were recorded in two patients. Physiotherapists performed 1.2?±?0.4 home visits, 1.6?±?0.9 phone calls and 4.5?±?2.8 videoconference-sessions per patient. At least three sessions/week of home exercises were performed by 31% of patients, two sessions by 54%. At the end of the program, global functional capacity improved significantly (P?<?0.001), in particular, static (P?<?0.001) and dynamic (P?=?0.0004) postural balance, upper limb dexterity of the paretic side (P?=?0.01), and physical performance (P?=?0.002). Symptoms of depression and caregiver strain also improved.

Conclusion: The home-based program was feasible and effective in both sub-acute and chronic post-stroke patients, improving their recovery, and maintaining the benefits reached during inpatient rehabilitation     

Effects of weight-shift training on walking ability,ambulation, and weight distribution in individuals with chronic stroke: a pilot study

Background: People with gait difficulties after a stroke usually have an asymmetrical gait and slower gait speed than age-matched controls. These difficulties restrict people with stroke in their daily life activities.

Objective: This pilot study sought to evaluate the effects of weight-shift training on gait, weight distribution in standing, and ambulation in people with gait difficulties after a stroke.

Methods: Ten subjects with chronic stroke (3–11?years since insult) and remaining gait difficulties participated in a 3-week weight-shift training program. Spatial and temporal gait parameters were assessed pre-, post-, and 3-month post-training with a motion analysis system. Weight distribution was assessed with force plates and ambulation with the Swedish version of the Clinical Outcome Variables Scale (S-COVS). Wilcoxon signed-rank tests were used to explore differences between test occasions.

Results: Significant changes were seen between pre-and post-tests in decreased stance time on the non-paretic leg (P?=?0.005) and increased score on the S-COVS (P?=?0.043). At the 3-month follow-up test, the subjects had also increased their gait speed significantly (P?=?0.037). Standing weight distribution did not change between pre- and post-tests (P?=?0.575), but between the pre-and follow-up tests it shifted from the paretic leg to the non-paretic (P?=?0.007).

Conclusion: Weight-shift training seems to improve gait and ambulation in subjects with chronic stroke, but not with standing weight distribution. However, this pilot study has several limitations and a larger sample size with a control group is necessary.     

The bilateral movement condition facilitates maximal but not submaximal paretic-limb grip force in people with post-stroke hemiparesis

ObjectivesAlthough healthy individuals have less force production capacity during bilateral muscle contractions compared to unilateral efforts, emerging evidence suggests that certain aspects of paretic upper limb task performance after stroke may be enhanced by moving bilaterally instead of unilaterally. We investigated whether the bilateral movement condition affects grip force differently on the paretic side of people with post-stroke hemiparesis, compared to their non-paretic side and both sides of healthy young adults.MethodsWithin a single session, we compared: (1) maximal grip force during unilateral vs. bilateral contractions on each side, and (2) force contributed by each side during a 30% submaximal bilateral contraction.ResultsHealthy controls produced less grip force in the bilateral condition, regardless of side (?2.4% difference), and similar findings were observed on the non-paretic side of people with hemiparesis (?4.5% difference). On the paretic side, however, maximal grip force was increased by the bilateral condition in most participants (+11.3% difference, on average). During submaximal bilateral contractions in each group, the two sides each contributed the same percentage of unilateral maximal force.ConclusionsThe bilateral condition facilitates paretic limb grip force at maximal, but not submaximal levels.SignificanceIn some people with post-stroke hemiparesis, the paretic limb may benefit from bilateral training with high force requirements.     

Non-paretic quadriceps activity influences paretic quadriceps activity post-stroke

Objective

Inappropriate muscle activity is common following stroke. Paretic muscle activation may be influenced by non-paretic volitional activation. We examined the influence of non-paretic quadriceps activation on paretic quadriceps excitability.

Methods

Individuals with chronic stroke performed bilateral and unilateral (paretic and non-paretic) maximum voluntary isometric contractions. Peak torque and muscle activity were compared between conditions. An instrumented tendon tapper elicited a patellar tendon reflex of the relaxed paretic leg while the non-paretic leg was relaxed and pre-activated. The threshold to elicit a paretic quadriceps response was compared between conditions.

Results

During the bilateral MVIC, the paretic quadriceps generated less absolute torque, but greater relative torque than the non-paretic side when normalized to the respective unilateral condition (p < 0.05). During reflex testing, the tendon tapping threshold to elicit paretic muscle and torque responses decreased with non-paretic activity (p < 0.05).

Conclusions

Concurrent non-paretic activation resulted in a relative disinhibition of the paretic quadriceps. The paretic limb’s inability to remain inactive during isolated non-paretic contractions implies increased excitation or decreased inhibition of paretic motor pools, although the source remains unknown.

Significance

Unwanted muscle activity during reciprocal tasks (gait training) may be due to contralateral effects of non-paretic muscle activity.     

Ultrasonographic measurements of the metacarpal and talar cartilage thicknesses in hemiplegic patients after stroke

Background: Immobilization of the extremities after stroke is known to be the foremost reason of articular cartilage degeneration and musculoskeletal ultrasound (US) has become increasingly important in the assessment of joint cartilage. To the best of our knowledge, US measurements of the metacarpal and talar cartilage thicknesses in hemiplegic patients after stroke have not been performed before.

Objectives: The aim of the study was to explore whether metacarpal and talar cartilage thicknesses were affected after stroke using US.

Methods: Fifty-eight patients (33 M and 25 F) with unilateral hemiplegia after stroke were enrolled between April and June 2015. Age, sex, body mass index, paretic side, and underlying etiology (ischemic or hemorrhagic) were noted. Modified Ashworth scale, Brunnstrom motor recovery stage (BMRS), motor functional independence measure and functional ambulation category were recorded. A 5–12 MHz linear array probe was used for ultrasonographic cartilage measurements at 2nd, 3rd, and 4th metacarpal heads and talus.

Results: When compared with the non-paretic side, metacarpal (but not talar) cartilage thicknesses were found to be less on the paretic side (significant for the 3rd and 4th ones) (both p < 0.05). Subgroup analysis yielded thinner 3rd and 4th metacarpal cartilage thicknesses between the groups in patients with BMRS 1–3 (p = 0.009 and 0.054, respectively) but not in patients with BMRS 4–6 (p = 0.416 and 0.571, respectively).

Conclusions: We may conclude that metacarpal (but not talar) cartilage is thinner on the paretic side of stroke patients that seems to be less with better motor functioning.     

Prevalence,pattern and impact of depression on quality of life of stroke survivors

Abstract

Objective. This study documented the incidence, pattern and impact of depression on QoL of stroke-survivors within 6-month post-stroke. Methods. This study involved 65 stroke survivors consecutively recruited at ictus from a tertiary health institution in Nigeria. The National Institute of Health Stroke-Scale, Stroke-Specific Quality-of-Life (SSQOL), international classification of diseases (tenth edition) and Center for Epidemiological Scale-Depression (CES-D) were administered at ictus to assess stroke-severity, QoL and depression respectively. The SSQOL, ICD-10 and CES-D were subsequently administered every other week for 6 months. Data were treated using Spearman's correlation coefficient, Mann–Whitney U-test and multivariable stepwise linear regression analysis (P=0.05). Results. Participants were age 58.1±15.7 years; 38 and 27 hemorrhagic and ischaemic stroke respectively. Twenty-six (40%) and 60.0% had moderate and severe stroke, respectively. The QoL at post-stroke periods were significantly influenced (P<0.05) by depression, age, marital status, spouse supports, stroke-severity, and educational-attainment. Depression determined (P<0.05) poor QoL in stroke-survivors. Co-morbidity with stroke severity was a determinant (P<0.05) of poor QoL and death. The haemorrhagic stroke survivors had significantly higher (P<0.05) QoL at post-stroke periods. Conclusion. Depression is associated with stroke. It is common within the first 6 months post-stroke and has negative impact on quality of life of stroke-survivors.