Investigating the Relationships Between Three Important Functional Tasks Early After Stroke: Movement Characteristics of Sit-To-Stand, Sit-To-Walk, and Walking.

Background: Walking, sit-to-stand (STS) and sit-to-walk (STW) are all considered important functional tasks in achieving independence after stroke. Despite knowledge that sensitive measurement of movement patterns is crucial to understanding neuromuscular restitution, there is surprisingly little information available about the detailed biomechanical characteristics of, and relationships between, walking, sit-to-stand and sit-to-walk, particularly in the important time window early after stroke. Hence, here, the study aimed to: Identify the biomechanical characteristics of and determine any differences in both movement fluidity (hesitation, coordination and smoothness) and duration of movement phases, between sit-to-stand (STS) and sit-to-walk (STW) in people early after stroke.Determine whether measures of movement fluidity (hesitation, coordination, and smoothness) and movement phases during sit-to-stand (STS) and/or sit-to-walk (STW) are correlated strongly to commonly used measures of walking speed and/or step length ratio in people early after stroke. Methods: This study consisted of secondary data analysis from the SWIFT Cast Trial. Specifically, we investigated movement fluidity using established assessments of smoothness, hesitation and coordination and the time duration for specific movement phases in a group of 48 people after stroke. Comparisons were made between STS and STW and relationships to walking measures were explored. Results: Participants spent significantly more time in the initial movement phase, flexion momentum, during STS [mean time (SD) 1.74 ±1.45 s] than they did during STW [mean time (SD) 1.13 ± 1.03 s]. STS was also completed more smoothly but with more hesitation and greater coordination than the task of STW. No strong relationships were found between movement fluidity or duration with walking speed or step length symmetry. Conclusions: Assessment of movement after stroke requires a range of functional tasks and no one task should predominate over another. Seemingly similar or overlapping tasks such as STS and STW create distinct biomechanical characteristics which can be identified using sensitive, objective measures of fluidity and movement phases but there are no strong relationships between the functional tasks of STS and STW with walking speed or with step-length symmetry.

Community cycling exercise for stroke survivors is feasible and acceptable.

Background: Physical activity is recommended after stroke but levels for stroke survivors are typically low. The use of indoor recumbent cycling, delivered through local government leisure facilities, may increase access to exercise among stroke survivors. Objective: This study aimed to evaluate the acceptability and feasibility of an indoor cycling program delivered through existing local government services. Methods: Participants were recruited through stroke liaison nurses and public advertising. After a home visit to assess eligibility and conduct psychological and general health assessments, participants attended their local leisure center for an initial fitness test and short battery of physical tests. Then, an 8 week training program was designed with weekly goals. Following the program the assessments were retaken along with an evaluation questionnaire. In-depth, semi-structured, interviews were conducted with 15 participants and five fitness coaches. Results: One hundred fifteen individuals volunteered to participate during a 10-month recruitment period, 77 met the inclusion criteria and consented, 66/77 (86%) completed the program including all nine non-ambulatory participants. The program and procedures (recruitment and outcome measures) were feasible and acceptable to participants (81% reported following the program). Participants were generally very positive about the experience. Significant improvements in sit-to-stand capacity (Mpre = 25.2 s, Mpost = 19.0 s, p = .002), activities of daily living (NEADL, Mpre = 12.2, Mpost = 13.2, p = .002), psychosocial functioning (SAQOL, Mpre = 3.82, Mpost = 4.15, p = .001), energy (SAQOL, Mpre = 3.75, Mpost = 4.02, p = .018) and depression (GHQ, Mpre = .97, Mpost = .55, p = .009) were observed. Conclusion: A cycling-based exercise program delivered through local leisure center staff and facilities was shown to be feasible and acceptable for people living with stroke.

Falls prevention advice and visual feedback to those at risk of falling: study protocol for a pilot randomized controlled trial.

BACKGROUND: Studies have shown that functional strength and balance exercises can reduce the risk of falling in older people if they are done on a regular basis. However, the repetitive nature of these exercises; combined with the inherent lack of feedback of progress may discourage seniors from exercising in the home, thereby rendering such an intervention ineffective. This study hypothesizes that the use of visual feedback and multimodal games will be more effective in encouraging adherence to home rehabilitation than standard care; thereby promoting independence and improving the quality of life in older adults at risk of falling. METHODS: A parallel-group pilot randomized controlled trial with 3 groups of participants will be conducted in the home for 12 weeks. Participants will include older adults who have been identified as at risk of falling (n = 48), over the age of 65, living in the community, and suitable for a home exercise intervention. The primary outcome is adherence to exercise. Secondary outcomes include: variability in stride length, stride time and double support time (DST); walking speed; Timed up and go test (TUG); Falls Efficacy Scale International (FES-I); CONFbal scale; Romberg's test; and quality of life measures (SF-12 and EuroQol EQ-5D). Qualitative assessments on personal experiences with rehabilitation tools will be done before and after the trial. DISCUSSION: This study will investigate the use of visual feedback and engaging multimodal activities to address the problem of non-compliance to home exercises for falls rehabilitation. One of the unique qualities of this study is the adaptation of special participatory design methods through which the end users (fallers) will be involved in the design of the proposed rehabilitation tools at various stages of the design process. TRIAL REGISTRATION: ISRCTN79967470.

The SWIFT Cast trial protocol: a randomized controlled evaluation of the efficacy of an ankle-foot cast on walking recovery early after stroke and the neural-biomechanical correlates of response.

RATIONALE: An ankle-foot cast may enable people to repeatedly practice walking with a more normal movement pattern early after stroke. AIMS: To evaluate the clinical efficacy of using an ankle-foot cast [soft scotch ankle-foot (SWIFT) Cast] to enhance walking recovery and to find whether site of stroke lesion and/or baseline biomechanical characteristics predict response to a SWIFT Cast. DESIGN: Randomized, controlled, observer-blind trial. STUDY: Participants (n = 120), 3-42 days after stroke with walking difficulty. All will receive conventional physical therapy. Those allocated to the experimental group will also receive a SWIFT Cast for up to six-weeks. During therapy sessions, the SWIFT Cast will be worn for retraining of walking as clinically appropriate. Outside therapy sessions, participants will initially wear the SWIFT Cast for the whole of their waking day, and this will be adjusted as clinically appropriate. OUTCOMES: Measures will be undertaken before randomization, six-weeks thereafter and six-months after stroke. Primary outcome will be walking speed. Secondary outcomes will include the Functional Ambulation Category and efficiency of gait (e.g. step-time symmetry). Structural brain imaging using magnetic resonance imaging (standard fluid attenuated inversion recovery and T1-weighted high-resolution 'volume' spoiled gradient) will be undertaken at baseline. The clinical efficacy analysis will use analysis of covariance. The relationship between clinical response to therapy and biomechanical data will use correlation and multivariate regression techniques as required. For neuroimaging data, the relationship to clinical response to therapy will be computed using voxel-based lesion-symptom mapping. An interaction test across groups will identify which voxels are associated with different mean levels of treatment efficacy.