Aortic pulse wave morphology in individuals after chronic stroke: interarm comparison wave morphology after chronic stroke.

CONTEXT: Vascular changes can be a risk factor for recurrent and new events of stroke. However, few information is known regarding the variables related to aortic pulse wave morphology in stroke individuals. OBJECTIVE: To analyze aortic pulse wave morphology (arterial stiffness indices, hemodynamics and vascular variables) and to compare the paretic and non-paretic sides in individuals after chronic stroke. DESIGN: In this cross-sectional study stroke individuals had arterial stiffness indices, hemodynamics and vascular variables assessed with brachial artery oscillometry. T-test (CI95%) was used in order to compare the variables between the paretic and non-paretic sides. RESULTS: Twenty individuals were included, 65% men (60.3 SD 16.7 years). The following variables: (mean difference [CI95%]): coefficient of reflection (-2.33 [-4.60 to -0.07]), peak of ejection wave, P1 (5.32 [2.75 to 7.90] and peak of ejection wave, P2 (6.17 [2.55 to 9.78]), central diastolic blood pressure (mean difference [IC95%]): (-3.75 [-6.09 to -1.40]), central systolic blood pressure (-6.17 [-9.74 to -2.59]), mean arterial pressure (-4.46 [-7.08 to -1.84]), peripheral diastolic blood pressure (-3.48 [-5.94 to -1.02]) and peripheral systolic blood pressure (-5.53 [-9.54 to -1.52]) were higher in paretic than non-paretic side. Hemodynamics parameters were similar in both sides. CONCLUSIONS: In this study we demonstrated, for the first time, that many parameters from aortic pulse wave were higher in paretic compared with non-paretic side in individuals after chronic stroke, suggesting that peripheral vascular changes affect heart-vascular coupling in these individuals.

Oxygen uptake efficiency slope in community-dwelling ambulant stroke survivors during walking and stair climbing: a cross-sectional study.

BACKGROUND: Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. OBJECTIVES: To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. METHODS: This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. RESULTS: The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p = .01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI -73 to 772, p = .10). CONCLUSIONS: Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity.

Oxygen pulse best predicts energy expenditure during stair ascent and descent in individuals with chronic stroke.

BACKGROUND: To determine whether minute ventilation-to-carbon dioxide production (VE/VCO2), oxygen pulse (VO2/HR), and rate pressure product (RPP: VO2 * HR/1000) can explain energy expenditure during stair ascent/descent and whether energy expenditure during stair ascent/descent can discriminate between walking abilities in individuals with chronic stroke. MATERIALS AND METHODS: Regression analysis of cross-sectional data from 50 individuals between 1 and 4 years post-stroke was carried out to investigate the prediction of energy expenditure during stair ascent/descent. In addition, discriminant analysis was carried out to investigate the discrimination between walking abilities for energy expenditure: community (walking speed ≥ 0.8 m/s) and non-community (walking speed < 0.8 m/s) walkers. RESULTS: Oxygen pulse and rate pressure product were retained in the model. Oxygen pulse alone explained 70% of the variance in energy expenditure during stair ascent/descent. By adding rate pressure product, 79% of the variance was explained. Energy expenditure was able to discriminate the community from the non-community walkers, with a cutoff value of 13.8 ml∙kg-1∙min-1 and correctly classified 62% of the non-community and 78% of the community walkers. CONCLUSION: Oxygen pulse and rate pressure product significantly predicted energy expenditure during stair ascent/descent in individuals with chronic stroke. Energy expenditure during stair ascent/descent discriminated community from non-community walkers.

mHealth technologies used to capture walking and arm use behavior in adult stroke survivors: a scoping review beyond measurement properties.

PURPOSE: We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitators and barriers toward adoption in research and clinical practice. MATERIALS AND METHODS: Using Arksey and O'Malley's framework, two independent reviewers determined eligibility and performed data extraction. We conducted an online consultation survey exercise with 37 experts. RESULTS: Sixty-four out of 1380 studies were included. A majority reported on lower limb behavior (n = 32), primarily step count (n = 21). Seventeen studies reported on arm-hand behaviors. Twenty-two studies reported metrics of intensity, 10 reported on energy expenditure. Reliability and validity were the most frequently reported properties, both for commercial and non-commercial devices. Facilitators and barriers included: resource costs, technical aspects, perceived usability, and ecological legitimacy. Two additional categories emerged from the survey: safety and knowledge, attitude, and clinical skill. CONCLUSIONS: This provides an initial foundation for a field experiencing rapid growth, new opportunities and the promise that mHealth technologies affords for envisioning a better future for stroke survivors. We synthesized findings into a set of recommendations for clinicians and clinician-scientists about how best to choose mHealth technologies for one's individual objective.Implications for RehabilitationRehabilitation professionals are encouraged to consider the measurement properties of those technologies that are used to monitor functional locomotor and object-interaction skills in the stroke survivors they serve.Multi-modal knowledge translation strategies (research synthesis, educational courses or videos, mentorship from experts, etc.) are available to rehabilitation professionals to improve knowledge, attitude, and skills pertaining to mHealth technologies.Consider the selection of commercially available devices that are proven to be valid, reliable, accurate, and responsive to the targeted clinical population.Consider usability and privacy, confidentiality and safety when choosing a specific device or smartphone application.

Fall Efficacy Scale-International cut-off score discriminates fallers and non-fallers individuals who have had stroke.

BACKGROUND: Falls, which are common events after stroke, may lead to activity limitations and increased dependence. It is important to identify which commonly employed clinical measures could differentiate individuals, who are fallers from the non-fallers. AIM: To investigate specific cut-off values of clinical measures that could discriminate fallers and non-fallers individuals with chronic stroke. METHOD: This cross-sectional study involved 105 community-dwelling individuals with stroke. The primary outcome was report of falls over the last six months. The clinical predictors included measures of mobility (walking speed, stair ascent/descent cadences, time to perform the Timed Up and Go test, and ABILOCO) and the Fall Efficacy Scale - International (FES-I) scores. To identify which measures were able to detect between-group differences, independent Student's t-tests were employed. For measures which were able to discriminate fallers from the non-fallers, the Receiver Operating Characteristics (ROC) and the Area Under the ROC Curve (AUC) were calculated. RESULTS: Out of the 105 participants (61 men), 41% reported falls over the previous 6 months. Stair ascent cadence, ABILOCO, and FES-I scores significantly differentiated the groups, but only the FES-I demonstrated acceptable discriminatory ability (AUC = 0.71). The optimal FES-I cut-off score was 28 points (sensitivity = 0.71; specificity = 0.57; positive predictive value = 51%; and negative predictive value = 74%). CONCLUSIONS: The FES-I demonstrated good discriminatory ability to classify individuals with chronic stroke, who were fallers from the non-fallers. The use of the established cut-off value of 28 points is recommended and may help clinical reasoning and decision-making in stroke rehabilitation.

Treadmill walking improves walking speed and distance in ambulatory people after stroke and is not inferior to overground walking: a systematic review.

QUESTIONS: Does mechanically assisted walking improve walking speed, distance and participation compared with no/non-walking intervention or overground walking after stroke? Are any benefits maintained beyond the intervention period? DESIGN: Systematic review of randomised trials with meta-analysis. PARTICIPANTS: Ambulatory adults at any time after stroke. INTERVENTION: Mechanically assisted walking (treadmill or gait trainer) without body weight support. OUTCOME MEASURES: Walking speed, walking distance and participation. RESULTS: Sixteen trials involving 713 participants were included. The mean PEDro score of the trials was 6.3 (range 4 to 8). Treadmill walking increased walking speed by 0.13 m/s (95% CI 0.08 to 0.19) and distance by 46 m (95% CI 24 to 68) compared with no/non-walking intervention; these effects were largely maintained beyond the intervention. Treadmill walking had a similar or better effect on walking speed (MD 0.07 m/s, 95% CI 0.00 to 0.13) and distance (MD 18 m, 95% CI 1 to 36) compared with overground walking. The estimate of the relative effect of treadmill walking compared with overground walking on participation was very imprecise (SMD 0.16, 95% CI -0.15 to 0.48). CONCLUSION: This systematic review provides moderate-quality evidence that the effect of treadmill walking is the same as or better than the effect of overground walking for improving walking speed and distance in ambulatory people after stroke. Long-term effects and carryover benefits to participation remain uncertain. REVIEW REGISTRATION: PROSPERO (CRD42020162778).

Deficits in motor coordination of the paretic lower limb best explained activity limitations after stroke.

Objective: To explore the relationships between selected measures of motor impairments and activities involving the lower-limbs in ambulatory people with chronic stroke. Design: Motor impairment measures included maximal isometric strength and motor coordination. Activity measures included walking speed, stair ascent/descent cadences, and the time to perform the Timed Up and Go (TUG) test. Results: Ninety individuals were included. The correlations between all motor impairment and activity measures were significant (0.18 < r < 0.52, p < 0.05). Motor coordination and strength of the knee flexor muscles explained 30% (F = 20.3; p < 0.001) of the variance in walking speed, 32% (F = 19.1; p < 0.001) of stair ascent, and 31% (F = 16.8; p < 0.001) of stair descent cadence. Regarding the TUG, only motor coordination reached significance and explained 13% (F = 13.4; p < 0.001) of the variance. Conclusion: Measures of strength and motor coordination of the paretic lower limb were significantly correlated with all activity measures. However, despite the fact that knee flexor strength explained some variance in walking speed and stair ascent/descent cadences, motor coordination was the only measure that explained the variances in all three selected activity measures. These findings are innovative for neurological rehabilitation, since this is the first study to demonstrate that deficits in motor coordination of the paretic lower limb best explained limitations in performing different lower-limb activities.

Associations between walking speed and participation, according to walking status in individuals with chronic stroke.

BACKGROUND: Reduced walking speed (WS) may lead to restrictions in participation of individuals with stroke, however, the relationships between WS and participation still need to better clarified. OBJECTIVE: To evaluate the relationships between WS and participation and compare the levels of participation of individuals with chronic stroke, who were stratified according to their walking status. METHODS: One-hundred and five individuals with stroke (58±12 years; 61 men) participated. WS was measured by the 10-meter walking test and reported in m/s. The participants were stratified into three walking status groups: household (WS <0.4 m/s), limited-community (0.4 m/s-0.8 m/s), and full-community ambulation (>0.8 m/s). Participation was assessed by the Brazilian version of the Assessment of Life Habits 3.1 (LIFE-H 3.1-Brazil). RESULTS: Between-group analyses revealed statistically significant differences between the household, limited-community, and full-community ambulators regarding the LIFE-H 3.1 total (F = 17.5; p < 0.0001), as well the daily activity (F = 12.3; p < 0.0001) and social role (F = 19.0; p < 0.0001) domain scores. Measures of WS were correlated with the daily activity (r = 0.50, p < 0.0001), social role (r = 0.53, p < 0.0001), total LIFE-H scores (r = 0.53, p < 0.0001), and most of the LIFE-H categories (r = 0.23-0.56). CONCLUSIONS: WS was significantly correlated with participation and was able to distinguish between individuals with stroke, who had different levels of participation.

Validity and reliability of the Modified Sphygmomanometer Test with fixed stabilization for clinical measurement of muscle strength.

OBJECTIVE: To investigate the concurrent validity of the Modified Sphygmomanometer Test (MST) with fixed stabilization, compared to the portable dynamometer, and to verify its test-retest and inter-raterreliability. METHODS: Methodological study. The muscle strength of the following groups was measured: flexors and extensors of the wrist, of the hip, and of the knee and plantar flexors. The Tycos® aneroid sphygmomanometer and the Microfet 2® dynamometer were used. Stabilization was performed using the Mullingan® belt. Descriptive statistics were performed for characterization of the sample. To determine the validity of the MST with fixed stabilization, comparing it with the portable dynamometer, we investigated the correlation between the measurements obtained with the two instruments using the Pearson correlation coefficient. Intraclass Correlation Coefficient (ICC) was used to investigate inter-examiner and test-retest reliability (α = 0.05). RESULTS: 59 individuals were included (1176 evaluations). A statistically significant correlation of moderate to high magnitude (0.58 ≤ r ≤ 0.81) was observed for concurrent validity of the MST with fixed stabilization versus the portable dynamometer for all muscle groups. Regarding inter-rater reliability, it was observed statistically significant ICC considered excellent to good (0.72 ≤ r ≤ 0.94) for all muscle groups. Regarding test-retest reliability, first evaluator presented good to excellent ICC (0.64 ≤ r ≤ 0.94), while second evaluator presented good to excellent ICC (0.74 ≤ r ≤ 0.96) for all muscle groups. CONCLUSION: The MST with fixed stabilization is valid and reliable for clinical measurement of muscle strength and can overcome previous limitations reported in the literature.

Validity of the accelerometer and smartphone application in estimating energy expenditure in individuals with chronic stroke.

OBJECTIVE: To examine the concurrent validity of the GT3X® ActiGraph accelerometer and Google Fit® smartphone application in estimating energy expenditure in people who had suffered a stroke, during fast overground walking. METHODS: Thirty community-dwelling stroke individuals walked on a 10-meter hallway over 5min at their fastest speeds, wearing a Cortex Metamax 3B® ergoespirometer, a GT3X® ActiGraph accelerometer, and a smartphone with the Google Fit® application. Pearson correlation coefficients were calculated to verify the associations between measures of energy expenditure, in kilocalories (kcal), estimated by both devices and those obtained with the Cortex Metamax 3B® ergoespirometer (gold-standard measure). RESULTS: Fair association was found between the energy expenditure values estimated from the combined formula of the ActiGraph GT3X® and those obtained with the gold-standard measure (r=0.37; p=0.04). No significant associations were found between the energy expenditure values estimated by the Google Fit® application and those provided by the gold-standard measure. CONCLUSIONS: The findings demonstrated that both the GT3X®ActiGraph accelerometer and the Google Fit® smartphone application do not provide valid measures of energy expenditure in chronic stroke individuals during fast overground walking.

Relationship between oxygen cost of walking and level of walking disability after stroke: An experimental study.

BACKGROUND AND PURPOSE: Since physical inactivity is the major risk factor for recurrent stroke, it is important to understand how level of disability impacts oxygen uptake by people after stroke. This study investigated the nature of the relationship between level of disability and oxygen cost in people with chronic stroke. METHODS: Level of walking disability was measured as comfortable walking speed using the 10-m Walk Test reported in m/s with 55 ambulatory people 2 years after stroke. Oxygen cost was measured during 3 walking tasks: overground walking at comfortable speed, overground walking at fast speed, and stair walking at comfortable speed. Oxygen cost was calculated from oxygen uptake divided by distance covered during walking and reported in ml∙kg-1 ∙m-1 . RESULTS: The relationship between level of walking disability and oxygen cost was curvilinear for all 3 walking tasks. One quadratic model accounted for 81% (95% CI [74, 88]) of the variance in oxygen cost during the 3 walking tasks: [Formula: see text] DISCUSSION: The oxygen cost of walking was related the level of walking disability in people with chronic stroke, such that the more disabled the individual, the higher the oxygen cost of walking; with oxygen cost rising sharply as disability became severe. An equation that relates oxygen cost during different walking tasks according to the level of walking disability allows clinicians to determine oxygen cost indirectly without the difficulty of measuring oxygen uptake directly.

Energy expenditure and cost of walking and stair climbing in individuals with chronic stroke.

BACKGROUND: Subjects with stroke show higher energy cost (EC) during walking, when compared to healthy individuals, but the mechanisms are not fully understood. Additionally, the behavior of physiological variables during other activities has not been investigated. OBJECTIVES: To investigate energy expenditure (EE) and EC during the six-minute walking test (6MWT) and stair climb test (SCT) in chronic stroke subjects compared to healthy controls. METHODS: Cross-sectional study in which stroke subjects (n=18) (community-walking speed ≥0.8m/s) or limited-community <0.8m/s walkers and matched healthy controls (n=18) had their EE and EC assessed during the 6MWT and SCT with a portable monitoring system. RESULTS: Significant differences in EE were observed for both the 6MWT (MD 7.29; 95%CI 4.08-10.50) and SCT (MD 8.53; 95%CI 5.07-12.00) between the stroke and control groups, but not between the stroke subgroups. Significant between-group differences in EC were found for both the 6MWT and SCT. For the 6MWT, differences were significant between the limited-community and the community walkers (MD 0.19; 95%CI 0.05-0.33) and controls (MD 0.17; 95%CI 0.04-0.29). No significant differences were found between the community walkers and controls (MD 0.02; 95%CI -0.09 to 0.13). For the SCT, the limited-community walkers showed highest EC, followed by the community walkers, and controls. CONCLUSIONS: Both stroke subgroups demonstrated lower EE compared to healthy controls. During the 6MWT, the limited-community walkers demonstrated higher EC compared to the community walkers and controls. During the SCT, the limited-community walkers demonstrated higher EC, followed by the community walkers, and controls.

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke.

PURPOSE: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects. METHODS: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits). RESULTS: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F = 29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F = 20.6; p< .0001). CONCLUSIONS: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke. Implications for Rehabilitation Residual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1. It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

Functional capacity of patients with chronic stroke based upon their physical activity levels / Capacidade funcional de indivíduos pós-acidente vascular cerebral crônico baseada nos níveis de atividade física

Introduction: People with stroke commonly show low levels of physical activity and reduced functional capacity, independent of the severity of the impairments. The use of simple measures that are able to produce transferable information from clinical practice to life in society is crucial within clinic contexts. Objective: To compare the functional capacity of patients with chronic stroke based upon their physical activity levels. Methods: For this cross sectional study, functional capacity and levels of physical activity were assessed by the Duke Activity Status Index (DASI) and the adjusted activity score (AAS) of the Human Activity Profile (HAP), respectively. One-way analysis of variance (ANOVA), followed by LSD post-hoc tests were employed to investigate differences between the physical activity groups regarding their DASI scores. Results: Fifty-one individuals with mean age 58.8 ± 13.5 and a mean time since the onset of stroke of 25.5 ± 13.9 months participated. According to their HAP AAS, 18 individuals were classified as impaired, 28 as moderately active, and five as active. Between-group differences were observed for the DASI scores [F(2,48)=13.72; p < 0.01]. Conclusion: Increases in functional capacity were observed with increases in physical activity levels.(AU)

Introdução: Indivíduos pós acidente vascular cerebral (AVC) geralmente apresentam baixos níveis de atividade física e redução da capacidade funcional, independente da gravidade. O uso de medidas simples, capazes de transferir informações da prática clínica para a vida em sociedade, é crucial dentro do contexto clínico. Objetivo: Comparar a capacidade funcional dos indivíduos com AVC crônico estratificados pelo nível de atividade física. Métodos: Para este estudo transversal, a capacidade funcional e os níveis de atividade física foram avaliados pelo Duke Activity Status Index (DASI) e pelo escore de atividade ajustado (EAA) do Perfil de Atividade Humana (PAH), respectivamente. Análise de variância One-way (ANOVA), seguida de testes post-hoc LSD foram realizados para investigar diferenças entre os níveis de atividade física considerando os escores do DASI. Resultados: Cinquenta e um indivíduos com idade média de 58,8 ± 13,5 anos e tempo médio pós AVC de 25,5 ± 13,9 meses participaram. De acordo com o EAA PAH, 18 indivíduos foram classificados como inativos, 28 como moderadamente ativos, e 5 como ativos. Diferenças entre-grupos foram observadas para os escores do DASI [F(2,48) = 13,72; p < 0,01]. Conclusão: Aumentos na capacidade funcional foram observados com aumentos nos níveis de atividade física. (AU)

Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.

QUESTION: After stroke, does respiratory muscle training increase respiratory muscle strength and/or endurance? Are any benefits carried over to activity and/or participation? Does it reduce respiratory complications? DESIGN: Systematic review of randomised or quasi-randomised trials. PARTICIPANTS: Adults with respiratory muscle weakness following stroke. INTERVENTION: Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength. OUTCOME MEASURES: Five outcomes were of interest: respiratory muscle strength, respiratory muscle endurance, activity, participation and respiratory complications. RESULTS: Five trials involving 263 participants were included. The mean PEDro score was 6.4 (range 3 to 8), showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training increased maximal inspiratory pressure by 7 cmH2O (95% CI 1 to 14) and maximal expiratory pressure by 13 cmH2O (95% CI 1 to 25); it also decreased the risk of respiratory complications (RR 0.38, 95% CI 0.15 to 0.96) compared with no/sham respiratory intervention. Whether these effects carry over to activity and participation remains uncertain. CONCLUSION: This systematic review provided evidence that respiratory muscle training is effective after stroke. Meta-analyses based on five trials indicated that 30minutes of respiratory muscle training, five times per week, for 5 weeks can be expected to increase respiratory muscle strength in very weak individuals after stroke. In addition, respiratory muscle training is expected to reduce the risk of respiratory complications after stroke. Further studies are warranted to investigate whether the benefits are carried over to activity and participation. REGISTRATION: PROSPERO (CRD42015020683). [Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF (2016) Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review.Journal of Physiotherapy62: 138-144].

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.

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. .

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke.

OBJECTIVES: To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter. METHOD: Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference. RESULTS: The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10). CONCLUSIONS: The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion.