Predictors of energy cost during stair ascent and descent in individuals with chronic stroke

[Purpose] This study aimed to determine which clinical measures of walking performance and lower limb muscle strength would predict energy cost during stair ascent and descent in community-dwelling individuals with stroke. [Subjects and Methods] Regression analysis of cross-sectional data from 55 individuals between one and five years post-stroke was used to investigate the measures of walking (speed and distance covered during the 6-minute walk test [6MWT]), and strength of the paretic knee extensor and ankle plantar flexor muscles would predict energy cost during stair ascent and descent. [Results] Three predictors (habitual walking speed, distance covered during the 6MWT, and strength of the paretic knee extensor muscles) were kept in the model. Habitual walking speed alone explained 47% of the variance in energy cost during stair ascent and descent. When the strength of the paretic knee extensor muscles was included in the model, the explained variance increased to 53%. By adding the distance covered during the 6MWT, the variance increased to 58%. [Conclusion] Habitual walking speed, distance covered during the 6MWT, and strength of the paretic knee extensor muscles were significant predictors of energy cost during stair ascent and descent in individuals with mild walking limitations.Key words: Stroke, Energy metabolism, Stairs     

Influences of hand dominance on the maintenance of benefits after home-based modified constraint-induced movement therapy in individuals with stroke

Objective:

To investigate the influence of hand dominance on the maintenance of gains after home-based modified constraint-induced movement therapy (mCIMT).

Method:

Aprevious randomized controlled trial was conducted to examine the addition of trunk restraint to the mCIMT. Twenty-two chronic stroke survivors with mild to moderate motor impairments received individual home-based mCIMT with or without trunk restraints, five times per week, three hours daily over two weeks. In this study, the participants were separated into dominant group, which had their paretic upper limb as dominant before the stroke (n=8), and non-dominant group (n=14) for analyses. The ability to perform unimanual tasks was measured by the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL), whereas the capacity to perform bimanual tasks was measured using the Bilateral Activity Assessment Scale (BAAS).

Results:

Analysis revealed significant positive effects on the MAL amount of use and quality of the movement scales, as well as on the BAAS scores after intervention, with no differences between groups. Both groups maintained the bimanual improvements during follow-ups (BAAS-seconds 0.1, 95% CI -10.0 to 10.0), however only the dominant group maintained the unilateral improvements (MAL-amount of use: 1.5, 95% CI 0.7 to 2.3; MAL-quality: 1.3, 95% CI 0.5 to 2.1).

Conclusions:

Upper limb dominance did not interfere with the acquisition of upper limb skills after mCIMT. However, the participants whose paretic upper limb was dominant demonstrated better abilities to maintain the unilateral gains. The bilateral improvements were maintained, regardless of upper limb dominance.