[Abstract] Compensation or Recovery? Altered Kinetics and Neuromuscular Synergies Following High-Intensity Stepping Training Poststroke

Abstract

Background. High-intensity, variable stepping training can improve walking speed in individuals poststroke, although neuromuscular strategies used to achieve faster speeds are unclear. We evaluated changes in joint kinetics and neuromuscular coordination following such training; movement strategies consistent with intact individuals were considered evidence of recovery and abnormal strategies indicative of compensation.

Methods. A total of 15 individuals with stroke (duration: 23 ± 30 months) received ≤40 sessions of high-intensity stepping in variable contexts (tasks and environments). Lower-extremity kinetics and electromyographic (EMG) activity were collected prior to (BSL) and following (POST) training at peak treadmill speeds and speeds matched to peak BSL (MATCH). Primary measures included positive (concentric) joint and total limb powers, measures of interlimb (paretic/nonparetic powers) and intralimb compensation (hip/ankle or knee/ankle powers), and muscle synergies calculated using nonnegative matrix factorization.

Results. Gains in most positive paretic and nonparetic joint powers were observed at higher speeds at POST, with decreased interlimb compensation and limited changes in intralimb compensation. There were very few differences in kinetic measures between BSL to MATCH conditions. However, the number of neuromuscular synergies increased significantly following training at both POST and MATCH conditions, indicating gains from training rather than altered speeds. Despite these results, speed improvements were associated primarily with changes in nonparetic versus paretic powers.

Conclusion. Gains in locomotor function were accomplished by movement strategies consistent with both recovery and compensation. These and other data indicate that both strategies may be necessary to maximize walking function in patients poststroke.

via Compensation or Recovery? Altered Kinetics and Neuromuscular Synergies Following High-Intensity Stepping Training Poststroke – Marzieh M. Ardestani, Catherine R. Kinnaird, Christopher E. Henderson, T. George Hornby, 2019

[ARTICLE] The Effect of High Intensity Training on Stroke Rehabilitation: A Systematic Review – Full Text

Abstract

Background and Purpose: Stroke is one of the leading causes of disability worldwide. Stroke can cause deficits in one’s ability to walk independently, cause deficits in balance, and lead to a variety of other health issues as a sequela of paresis and prolonged physical inactivity.1 The purpose of this systematic review is to evaluate the efficacy of high intensity training (HIT) for the rehabilitation of patients with stroke.

Methods: A systematic review was performed utilizing five databases using search terms “stroke rehabilitation” and “high intensity training”. Article titles and abstracts were screened to include key words “stroke”, “high intensity training”, “resistance training”, “interval training”, “power training”, or “step training”. Research studies using subjects with co-morbidities other than stroke and its residuum were excluded.

Results: After meeting the selection criteria, 10 studies were selected for review. A review of each article’s subject population, tests performed, intervention, and result, reveal that many types of high intensity training have a positive effect on functional and health outcomes in patients with stroke.

Conclusion: High intensity training (HIT) has a positive effect on the rehabilitative potential of patients with stroke. HIT is shown to improve patient’s respiratory function, walking ability, balance, functional ability and other key areas.

Introduction

Stroke can be defined as an acute neurologic dysfunction of vascular origin from a hemorrhagic or ischemic event causing a disruption of blood flow to tissues of the brain.2 Strokes are a global health issue affecting 16 million people each year. It is estimated that by the year 2030 there will be 77 million survivors of stroke worldwide. Each year, 114 of 100,000 people in the United States will suffer their first stroke, accounting for 75% of hospitalizations due to stroke. The remaining 25% of stroke hospitalizations are of patients with recurrent strokes. Patient risk factors for stroke include, but are not limited to hypertension, smoking, diabetes, obesity, dyslipidemia, and elevated homocysteine.3 The long-term implications of a stroke depend upon how early a stroke is recognized and treated. Clinical manifestations following a stroke can include a loss of balance, speech and visual deficits, cognitive dysfunction and hemiparesis. There is potential for the spontaneous recovery of certain deficits in the first few weeks following a stroke, however there is likelihood for long-term dysfunction. The most prevalent long-term dysfunction after a stroke are motor impairments secondary to hemiparesis; which reduces muscle mass and the force of muscle contraction causing lower limb weakness, loss of mobility and gait deficiencies of the affected side.2,3

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Figure 1: Flow diagram of Selection Process