Arterial Stiffness in Subacute Stroke: Changing Pattern and Relationship with Functional Recovery.

BACKGROUND: To examine changing patterns in arterial stiffness and functional outcome in patients with subacute stroke, and to determine which parameter shows a strong correlation with the reversal of arterial stiffness, during a 3-month period of comprehensive rehabilitation therapy. METHODS: This descriptive, observational cohort study enrolled 60 patients (43 male and 17 female; average age, 62.7 years), and all received conventional rehabilitation therapy, during a 3-month period. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness. Functional assessments included the 6-minute walk test (6MWT), Fugl-Meyer Assessment of hemiparetic upper and lower limbs, the functional ambulatory category, the Berg balance scale, the Korean Mini-Mental Status Examination, and the Korean-Modified Barthel Index. All measurements were conducted at baseline and 1 and 3 months after stroke onset. RESULTS: Rehabilitation therapy resulted in a statistically significant improvement in baPWV since 3 months post stroke. Another functional outcome measure showed statistically significant improvements since 1 month after rehabilitation. Multivariable linear regression analysis revealed that a change in baPWV was significantly correlated with changes in the 6MWT. CONCLUSIONS: Three months of comprehensive rehabilitation therapy led to statistically significant improvements in arterial stiffness and functional outcomes during the subacute phase of stroke. Thus, the comprehensive rehabilitation focused on improving gait endurance would be warranted in subacute stroke patients.

Preoperative physical performance predictors of self-reported physical function and quality of life in patients scheduled for total knee arthroplasty.

[Purpose] To determine the preoperative self-reported and performance-based physical function of patients with end-stage knee osteoarthritis who awaited total knee arthroplasty. The preoperative physical performance factors that predicted self-reported physical function and quality of life were also identified. [Subjects and Methods] All adults with end-stage knee osteoarthritis awaiting surgery were enrolled. Before surgery, self-reported disease-specific physical function and self-reported pain were measured using the Western Ontario McMaster Universities Osteoarthritis Index, self-reported quality of life was measured using the EuroQOL five dimensions questionnaire, and physical performance tests were performed, the 6 minute walk test, the timed up-and-go test, instrumental gait analysis, and measurement of isometric knee flexor and extensor strength of the surgical and nonsurgical knees. [Results] In total, 55 adults (49 females; 73.3 ± 6.1 years) were included. This study showed that several preoperative self-reported and physical performance factors were predictive of self-reported physical function and quality of life. [Conclusion] In patients with end-stage knee osteoarthritis, preoperative pain and dynamic balance ability were the most powerful predictors of self-reported physical function. Preoperative pain and exercise tolerance were the most powerful predictors of quality of life. Preoperative rehabilitation strategies that focus on dynamic balance, aerobic, and resistance exercises may improve surgical outcomes.

Clinical application of circuit training for subacute stroke patients: a preliminary study.

[Purpose] To investigate how task-oriented circuit training for the recovery motor control of the lower-extremity, balance and walking endurance could be clinically applied to subacute stroke inpatient group therapy. [Subjects and Methods] Twenty subacute stroke patients were randomly assigned to the intervention group (n=10) or the control group (n=10). The intervention consisted of a structured, progressive, inpatient circuit training program focused on mobility and gait training as well as physical fitness training that was performed for 90 minutes, 5 days a week for 4 weeks. The control group received individual physiotherapy of neurodevelopmental treatment for 60 minutes, 5 days a week for 4 weeks. Outcome measures were lower-extremity motor control, balance, gait endurance and activities of daily living before and after 4 weeks. [Results] There were no significant differences at baseline between the two groups. After 4 weeks, both groups showed significant improvements in all outcome measures, but there were no significant differences between the two groups during the invention period. [Conclusion] In spite of the small sample size, these findings suggest that task-oriented circuit training might be used as a cost-effective and alternative method of individual physiotherapy for the motor recovery of lower-extremity, balance and walking endurance of subacute stroke patients.

Hemiparetic Knee Extensor Strength and Balance Function Are Predictors of Ambulatory Function in Subacute Stroke Patients.

OBJECTIVE: To identify the potential predictors of ambulatory function in subacute stroke patients, and to determine the contributing factors according to gait severity. METHODS: Fifty-three subacute stroke patents were enrolled. Ambulatory function was assessed by gait speed and endurance. Balance function was evaluated by the Berg Balance Scale score (BBS) and the Timed Up and Go test (TUG). The isometric muscular strengths of bilateral knee extensors and flexors were measured using an isokinetic dynamometer. Cardiovascular fitness was evaluated using an expired gas analyzer. Participants were assigned into the household ambulator group (<0.4 m/s) or the community ambulator group (≥0.4 m/s) based on gait severity. RESULTS: In the linear regression analyses of all patients, paretic knee isometric extensor strength (p=0.007) and BBS (p<0.001) were independent predictors of gait endurance (R(2)=0.668). TUG (p<0.001) and BBS (p=0.037) were independent predictors of gait speed (R(2)=0.671). Paretic isometric extensor strength was a predictor of gait endurance (R(2)=0.340, p=0.008). TUG was a predictor of gait speed (R(2)=0.404, p<0.001) in the household ambulator group, whereas BBS was a predictive factor of gait endurance (R(2)=0.598, p=0.008) and speed (R(2)=0.713, p=0.006). TUG was a predictor of gait speed (R(2)=0.713, p=0.004) in the community ambulator group. CONCLUSION: Our results reveal that balance function and knee extensor isometric strength were strong predictors of ambulatory function in subacute stroke patients. However, they work differently according to gait severity. Therefore, a comprehensive functional assessment and a different therapeutic approach should be provided depending on gait severity in subacute stroke patients.

Use of an ankle-foot orthosis improves aerobic capacity in subacute hemiparetic stroke patients.

OBJECTIVE: To investigate aerobic capacity with and without an ankle-foot orthosis (AFO) in subacute hemiparetic stroke patients. DESIGN: Prospective crossover intervention study. SETTING: Rehabilitation clinic in secondary care. PATIENTS: Patients diagnosed with first-ever cerebral stroke involving the cortical or subcortical area resulting in hemiparesis (n = 15, 8 men and 7 women; average age, 62.1 years). METHODS: All subjects participated in 2 continuous, symptom-limited, low-velocity graded treadmill exercise stress tests under 2 different conditions, namely, with and without an AFO. The rest interval between tests was at least 48 hours. The order of exercise stress tests was randomized. MAIN OUTCOME MEASUREMENTS: To assess cardiorespiratory responses, oxygen consumption, heart rate, systolic blood pressure, diastolic blood pressure, rate-pressure product, and respiratory exchange ratio were measured continuously throughout the test, and peak values were obtained. The rating of perceived exertion was recorded immediately after each test. The percentage of the age-predicted maximal heart rate and total exercise duration were also measured. Gait function was assessed by the Six-Minute Walk Test. RESULTS: Using an AFO significantly increased peak oxygen consumption and Six-Minute Walk Test results. Peak values of each of heart rate, systolic blood pressure, diastolic blood pressure, rate-pressure product, and respiratory exchange ratio, rating of perceived exertion, percentage of age-predicted maximal heart rate, and total exercise duration were similar regardless of AFO use. CONCLUSIONS: Use of an AFO may improve aerobic capacity in subacute hemiparetic stroke patients, and may improve energy efficiency and gait endurance.

Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients.

OBJECTIVE: To investigate the effectiveness of commercial gaming-based virtual reality (VR) therapy on the recovery of paretic upper extremity in subacute stroke patients. METHODS: Twenty patients with the first-onset subacute stroke were enrolled and randomly assigned to the case group (n=10) and the control group (n=10). Primary outcome was measured by the upper limb score through the Fugl-Meyer Assessment (FMA-UL) for the motor function of both upper extremities. Secondary outcomes were assessed for motor function of both upper extremities including manual function test (MFT), box and block test (BBT), grip strength, evaluated for activities of daily living (Korean version of Modified Barthel Index [K-MBI]), and cognitive functions (Korean version of the Mini-Mental State Examination [K-MMSE] and continuous performance test [CPT]). The case group received commercial gaming-based VR therapy using Wii (Nintendo, Tokyo, Japan), and the control group received conventional occupational therapy (OT) for 30 minutes a day during the period of 4 weeks. All patients were evaluated before and after the 4-week intervention. RESULTS: There were no significant differences in the baseline between the two groups. After 4 weeks, both groups showed significant improvement in the FMA-UL, MFT, BBT, K-MBI, K-MMSE, and correct detection of auditory CPT. However, grip strength was improved significantly only in the case group. There were no significant intergroup differences before and after the treatment. CONCLUSION: These findings suggested that the commercial gaming-based VR therapy was as effective as conventional OT on the recovery of upper extremity motor and daily living function in subacute stroke patients.