Torque Onset Angle of the Knee Extensor as a Predictor of Walking Related Balance in Stroke Patients

Objective@#To investigate the relationship between the torque onset angle (TOA) of the isokinetic test for knee extensors in the paretic side and walking related balance in subacute stroke patients. @*Methods@#We retrospectively reviewed patients with first-ever strokes who have had at least two isokinetic tests within 6 months of onset. 102 patients satisfied the inclusion criteria. The characteristics of walking related balance were measured with the Berg Balance Scale sub-score (sBBS), Timed Up and Go test (TUG), 10-m Walk Test (10MWT) and Functional Independence Measure sub-score (sFIM). The second isokinetic test values of the knee extensor such as peak torque, peak torque to weight ratio, hamstring/quadriceps ratio, TOA, torque stop angle, torque at 30 degrees, and peak torque asymmetry ratio between paretic and non-paretic limb were also taken into account. Pearson’s correlation, simple regression and multiple regression analysis were used to analyze the correlation between TOA and walking related balance. @*Results@#TOA of the knee extensor of the paretic limb showed significant correlations with BBS, sBBS, TUG, 10MWT, and sFIM according to Pearson’s correlation analysis. TOA also had moderate to good correlations with walking related balance parameters in partial correlation analysis. In multiple regression analysis, TOA of the paretic knee extensor was significantly associated with walking related balance parameters. @*Conclusion@#This study demonstrated that TOA of the paretic knee extensor is a predictable parameter of walking related balance. Moreover, we suggest that the ability to recruit muscle quickly is important in walking related balance.

Relationship between Generalized Sarcopenia and the Severity of Dysphagia after a Stroke / 대한연하장애학회지

Objective@#Patients who have suffered a stroke may experience dysphagia, which could raise the risk of aspiration pneumonia and death. This is also a complication prevalent in older adults with various comorbidities. This study aimed at investigating the association between head lifting strength and dysphagia, particularly in each of the two phases of dysphagia, namely the oral and the pharyngeal phase, in stroke patients. @*Methods@#We prospectively recruited 64 patients within six months of their first-ever stroke. Head lifting strength, handgrip strength, and calf circumference were measured. The severity of dysphagia was evaluated using the videofluoroscopic dysphagia scale (VDS). Partial correlation and multiple linear regression analyses were applied to examine the association between head lifting strength and dysphagia. @*Results@#The subjects were comprised of 31 men and 33 women with a mean age of 63 years. The median National Institute of Health Stroke Scale (NIHSS) score was 5.5 (interquartile range 4.0-8.0). Based on the penetration-aspiration scale, 46 participants had dysphagia without aspiration and 18 had dysphagia with aspiration. The head lifting strength in the non-aspiration group was higher compared with the aspiration group. The head lifting strength was significantly correlated with the VDS-pharyngeal phase (r=−0.715) and the penetration-aspiration scale (r=−0.662). In the multiple linear regression analysis, head lifting strength was independently associated with pharyngeal-phase dysphagia (P＜0.001). @*Conclusion@#Head lifting strength is significantly associated with the severity of dysphagia in the pharyngeal phase.

The Impact of Cortical Cerebral Microinfarcts on Functional Outcomes in Patients With Ischemic Stroke

The present study examined cortical cerebral microinfarcts (CMIs) on a 3T magnetic resonance imaging and investigated the impact of CMIs on the comprehensive functional outcomes during the post-stroke rehabilitation period. Patients with acute phase of firstever ischemic stroke were retrospectively recruited (n = 62) and divided into 2 groups with and without CMIs. Clinical parameters including age, sex, stroke lesion laterality, location, the National Institutes of Health Stroke Scale score, as well as history of hypertension, dyslipidemia, diabetes mellitus, and smoking were obtained. Functional outcomes were assessed twice at baseline and one month later with the Korean version of the MiniMental State Examination, the Berg balance scale (BBS), and the functional independence measure. Partial correlation and multiple linear regression analyses were used to examine the relationship between the presence of CMIs and the change in functional outcomes. At least one CMI was reported in 27 patients, who were older (p = 0.043). The presence of CMIs was significantly associated with functional impairment in all 3 functional outcomes, after controlling for confounding factors (p < 0.05). CMIs might contribute to poor functional outcomes during the post-stroke rehabilitation period. These results suggest that CMIs should be considered when establishing rehabilitation treatment strategies or making a prognosis.