Posts Tagged muscle strength

[Abstract] Game-based hand resistance exercise versus traditional manual hand exercises for improving hand strength, motor function, and compliance in stroke patients: A multi-center randomized controlled study

Abstract

BACKGROUND:

Game-based exercise is effective for improving strength and motor function in stroke patients undergoing rehabilitation, and it creates fun and motivation for exercise.

OBJECTIVE:

We investigated the effect of game-based exercise on hand strength, motor function, and compliance in stroke patients.

METHODS:

Fifty stroke patients were randomly divided into experimental and control groups. The experimental group performed a game-based hand resistance exercise. This exercise was divided into isotonic and isometric types and was performed 30 min/day, 5 days/week, for 6 weeks with 70% of the 1-repetition maximum. In contrast, the control group was given a traditional manual exercise by the occupational therapist, and the type of exercise and time involved were the same as those in the experimental group. The primary outcome measure was hand strength test measured using a dynamometer. Secondary outcome measures were manual function tests (MFT) and hand function tests using box and block test (BBT). Subject-based reports of motivation, fun, pain/fatigue evaluated on 0 to 10 numeric rating scales were compared between groups.

RESULTS:

After training, hand strength, MFT and BBT was improved in the experimental group compared to the control group (P <  0.001, both). Subject-based reports of motivation and fun was significantly greater in the experimental group than the control group (P <  0.001, both), except to pain/fatigue (P = 0.728).

CONCLUSIONS:

In conclusion, we demonstrated that game-based exercise is more effective than manual exercise in improving muscle strength, motor function, and compliance in stroke patients.

 

via Game-based hand resistance exercise versus traditional manual hand exercises for improving hand strength, motor function, and compliance in stroke … – PubMed – NCBI

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[WEB PAGE] Plantar fasciitis stretches: 6 exercises and other home remedies – Videos

Best exercises and remedies for plantar fasciitis

Last reviewed
Foot stretches and exercises can help plantar fasciitis by relieving pain, improving muscle strength, and promoting flexibility in the foot muscles and ligaments.

Overuse, strain, and inflammation on the plantar fascia ligament that connects the heel to the toes cause the foot injury that doctors refer to as plantar fasciitis. The tissue that the condition affects is under the arch of the foot but can cause a stabbing pain in the heel.

Plantar fasciitis usually resolves within 6 to 18 months without treatment. With 6 months of consistent, nonoperative treatment, people with plantar fasciitis will recover 97 percent of the time.

In this article, we look at stretches and exercises for plantar fasciitis relief and recovery and other home remedies that could help.

Plantar fasciitis stretches

Plantar fasciitis may often be an overuse injury. Often, it occurs in runners or people who are overweight or obese. It may also cause tension in surrounding muscles, leading to pain beyond the heel.

A few simple stretches can reduce tension in the foot and calf. This offers both rapid pain relief and a steady improvement of symptoms over time.

People can perform these exercises two or three times every day. They should not be painful.

1. Stretching the calf

Man doing calf muscle and foot stretch against wall

Muscle tightness in the feet and calves can make the pain of plantar fasciitis worse. Loosening the calf muscles can relieve the pain. Try the following stretch:

  • lean your hands against a wall
  • straighten the knee of the affected leg and bend the other knee in front
  • keep both feet flat on the ground
  • there should be a stretching sensation in the heel and calf of the extended leg
  • hold for 10 seconds
  • repeat two to three times

2. Rolling stretch

Placing a round object under the foot and rolling back and forth can help loosen up the foot muscles. People can use a rolling pin, golf ball, or specialized foam roller for this. Sports stores and online stores sell foam foot rollers.

Use the following steps to stretch the foot:

  • sit tall on a chair
  • roll a round object under the arch of the foot
  • roll for 2 minutes

3. Stretching the plantar fascia

To relieve muscle tightness in the plantar fascia, try the following:

  • sitting on a chair, cross the injured heel over the other leg
  • hold the foot in your opposite hand
  • pull the toes toward the shin to create tension in the arch of the foot
  • place the other hand on the bottom of the foot to feel for tension in the plantar fascia
  • use a towel to grasp and stretch the foot if it is difficult to hold otherwise
  • hold for 10 seconds
  • repeat two to three times

4. Foot flexes

Pregnant woman stretching foot and leg with towel or exercise band

Flexing the foot increases blood flow to the area and relieves tension in the calves, which can help with pain. This exercise uses an elastic stretch band, which people can buy from sports stores or online.

Use the following steps:

  • sit on the floor with legs straight
  • wrap the elastic band around your foot, holding the ends in your hands
  • gently point the toes away from the body
  • slowly return to starting position
  • repeat 10 times

5. Towel curls

Curling a hand towel or facecloth with the toes can stretch the foot and calf muscles. Try doing these stretches before walking or doing any other morning tasks. Use the following steps:

  • sit on a chair with both feet flat and a small towel in front of the feet
  • grasp the center of the towel with your toes
  • curl the towel towards you
  • relax the foot and repeat five times
Marble feet exercise

6. Marble pickups

Picking up a marble with the toes will flex and stretch the foot muscles. Use the following steps:

  • sit on a chair with knees bent and feet flat on the floor
  • place 20 marbles and a bowl at your feet
  • pick up one marble at a time by curling your toes, and place the marble into the bowl
  • repeat 20 times

Other home remedies

A number of other home remedies can help reduce the inflammation and pain of plantar fasciitis:

The RICE method

When the pain first appears, keeping off the injured foot can help. First aid for a foot injury can include the RICE method:

  • Rest the painful area for a few days.
  • Ice the area for 20 minutes at a time to relieve inflammation.
  • Compress the area with a soft wrap to reduce swelling.
  • Elevate the area by putting the foot on a few pillows.

Elevating the foot with a pillow can be especially helpful when a person is sleeping.

Anti-inflammatory medication

Non-steroidal anti-inflammatory drugs (NSAID), such as ibuprofen, help to reduce both pain and inflammation. People may wish to take this medication as directed on the package or recommended by a doctor.

Some people find that a few weeks of NSAID treatment improves their symptoms.

Shoe inserts

Shoe inserts offer additional support to the arch of the foot. Inserts will limit stress on the plantar fascia and may be especially helpful to people who spend much of the day on their feet. Soft, supportive arch inserts may work as well.

Always speak to a doctor who specializes in foot health, called a podiatrist, for more information.

Massage

Some people find that massage helps with symptoms. Focus on massaging the arch of the foot around the injured area.

If surrounding muscles have become tense because of the pain, massage those too. Some people find relief from massaging the arch of the foot with an ice bottle.

Medical treatments

If stretches, exercises, and home remedies do not help, a doctor may recommend medical treatment. However, surgery is rarely needed.

A doctor may suggest the following:

Risk factors for plantar fasciitis

People who walk or run for exercise may be at risk of plantar fasciitis.

People who walk or run for exercise may be at risk of plantar fasciitis.

A thick mass of tissue called the plantar fascia connects the toes to the heel bone. Inflammation in this tissue, called plantar fasciitis, can cause intense pain in the heel.

The pain may get worse when getting out of bed or when standing after a long period of sitting.

Doctors do not fully understand why some people get this injury and others do not. Some evidence suggests that overuse causes the inflammation.

Risk factors for plantar fasciitis include:

  • spending long periods of time standing
  • walking or running for exercise
  • having tight calf muscles
  • overweight and obesity
  • pes cavus, a condition that causes the arch of the foot to be hollow when standing

Outlook

Plantar fasciitis will usually resolve by itself without treatment. People can speed up recovery and relieve pain with specific foot and calf stretches and exercises.

For some people, plantar fasciitis becomes a chronic condition. Symptoms may improve and then appear again, or the pain may remain consistent for a year or longer. A 2018 study suggests that people who have previously had the injury are more likely to have it again.

Because of the risk of chronic pain, people with plantar fasciitis should see a doctor about their symptoms. There are many different treatment options that may help.

 

via Plantar fasciitis stretches: 6 exercises and other home remedies

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[Abstract] Electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

Abstract

Background

Electromechanical and robot‐assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.

Objectives

To assess the effectiveness of electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy.

Search methods

We searched the Cochrane Stroke Group’s Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices.

Selection criteria

Randomised controlled trials comparing electromechanical and robot‐assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke.

Data collection and analysis

Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables.

Main results

We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot‐assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high‐quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high‐quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high‐quality evidence). Electromechanical and robot‐assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI ‐0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high‐quality evidence), and adverse events were rare.

Authors’ conclusions

People who receive electromechanical and robot‐assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.

Plain language summary

Electromechanical‐assisted training for improving arm function and disability after stroke

Review question

To assess the effects of electromechanical and robot‐assisted arm training for improving arm function in people who have had a stroke.

Background

More than two‐thirds of people who have had a stroke have difficulties with reduced arm function, which can restrict a person’s ability to perform everyday activities, reduce productivity, limit social activities, and lead to economic burden. Electromechanical and robot‐assisted arm training uses specialised machines to assist rehabilitation in supporting shoulder, elbow, or hand movements. However, the role of electromechanical and robot‐assisted arm training for improving arm function after stroke is unclear.

Study characteristics

We identified 45 trials (involving 1619 participants) up to January 2018 and included them in our review. Twenty‐four different electromechanical devices were described in the trials, which compared electromechanical and robot‐assisted arm training with a variety of other interventions. Participants were between 21 to 80 years of age, the duration of the trials ranged from two to 12 weeks, the size of the trials was between eight and 127 participants, and the primary outcome (activities of daily living: the most important target variable measured) differed between the included trials.

Key results

Electromechanical and robot‐assisted arm training improved activities of daily living in people after stroke, and function and muscle strength of the affected arm. As adverse events, such as injuries and pain, were seldom described, these devices can be applied as a rehabilitation tool, but we still do not know when or how often they should be used.

Quality of the evidence

The quality of the evidence was high.

 

via Electromechanical and robot‐assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke – Mehrholz, J – 2018 | Cochrane Library

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[WEB SITE] PaRRo Portable Arm Robot Designed for Rehab

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CPrehabrobot

University of Michigan researchers have designed a low-cost, portable arm rehabilitation robot, which they suggest can be used at home and facilitate motor recovery in patients with cerebral palsy, stroke, or spinal cord injury.

The development of the rehab robot, named PaRRo, is described in a study published in the journal IEEE Transactions on Biomedical Engineering.

PaRRo was designed to provide task-specific training, according to the researchers, in a news story from Cerebral Palsy News Today.

It features an effector at the end of a robotic arm, which is engineered to be maneuvered by the patient. The effector is connected to a system of brakes that offer resistance to the arm’s movement, training muscle strength and improving arm resistance.

The amount of resistance can be controlled by each patient, meaning that the arm exercise intensities can be adapted to each patient’s motor skills.

However, the news story continues, the rehab robot is passive, which means it does not have any computer control, nor does it actively operate by taking over from the user.

In their research, the team performed simulations to calculate the robot’s resistive force and workspace. They then constructed a prototype based on these results, which was tested in a healthy male volunteer with no neurological or orthopedic impairments.

Nine surface electrodes were placed in different muscles and recorded the muscle activity via electromyography.

Both the force generated by the robot and the force produced by the user matched those predicted by the simulations when the device was moved across different directions.

Electromyography results also revealed the robot was capable of generating resistive forces adjustable to the subject’s motor abilities, the news story explains.

“These results indicate that PaRRo is a feasible low-cost approach to provide functional resistance training to the muscles of the upper-extremity,” according to the researchers, in the study.

“The proposed robotic device could provide a technological breakthrough that will make rehabilitation robots accessible for small outpatient rehabilitation centers and in-home therapy,” they add.

[Source: Cerebral Palsy News Today]

 

via PaRRo Portable Arm Robot Designed for Rehab – Rehab Managment

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[Abstract] Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

Abstract

Objective

The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program.

Methods

Thirty-one post-stroke patients (60.6 ± 12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (FextFflex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test.

Results

The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both Fflex kg−1and Fext kg−1 had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fext kg−1 and, interestingly, even more prominent for Fflex kg−1.

Conclusions

MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors

Source: Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

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[ARTICLE] Transcranial Direct Current Stimulation Does Not Affect Lower Extremity Muscle Strength Training in Healthy Individuals: A Triple-Blind, Sham-Controlled Study – Full Text

The present study investigated the effects of anodal transcranial direct current stimulation (tDCS) on lower extremity muscle strength training in 24 healthy participants. In this triple-blind, sham-controlled study, participants were randomly allocated to the anodal tDCS plus muscle strength training (anodal tDCS) group or sham tDCS plus muscle strength training (sham tDCS) group. Anodal tDCS (2 mA) was applied to the primary motor cortex of the lower extremity during muscle strength training of the knee extensors and flexors. Training was conducted once every 3 days for 3 weeks (7 sessions). Knee extensor and flexor peak torques were evaluated before and after the 3 weeks of training. After the 3-week intervention, peak torques of knee extension and flexion changed from 155.9 to 191.1 Nm and from 81.5 to 93.1 Nm in the anodal tDCS group. Peak torques changed from 164.1 to 194.8 Nm on extension and from 78.0 to 85.6 Nm on flexion in the sham tDCS group. In both groups, peak torques of knee extension and flexion significantly increased after the intervention, with no significant difference between the anodal tDCS and sham tDCS groups. In conclusion, although the administration of eccentric training increased knee extensor and flexor peak torques, anodal tDCS did not enhance the effects of lower extremity muscle strength training in healthy individuals. The present null results have crucial implications for selecting optimal stimulation parameters for clinical trials.

Introduction

Transcranial direct current stimulation (tDCS) is a non-invasive cortical stimulation procedure in which weak direct currents polarize target brain regions (Nitsche and Paulus, 2000). The application of anodal tDCS to the primary motor cortex of the lower extremity transiently increases corticospinal excitability in healthy individuals (Jeffery et al., 2007Tatemoto et al., 2013) and improves motor function in healthy individuals and patients with stroke (Tanaka et al., 20092011Madhavan et al., 2011Sriraman et al., 2014Chang et al., 2015Montenegro et al., 20152016Angius et al., 2016Washabaugh et al., 2016). Thus, anodal tDCS has a potential to become a new adjunct therapeutic strategy for the rehabilitation of leg motor function and locomotion following a stroke.

Lower leg muscle strength is an important motor function required for patients who have had a stroke to regain activities of daily living (ADL). Lower leg muscle strength correlates with performance in activities, including sit-to-stand, gait, and stair ascent (Bohannon, 2007). Furthermore, lower leg muscle strength training increases muscle strength and improves ADL in patients with stroke (Ada et al., 2006). Therefore, lower leg muscle strength training is one of the important activities rehabilitating patients with stroke to regain their independence in ADL.

Several studies have examined the effect of a single session of tDCS on lower leg muscle strength, although the evidence is inconsistent (Tanaka et al., 20092011Montenegro et al., 20152016Angius et al., 2016Washabaugh et al., 2016). Its effects seem dependent on tDCS protocols, training tasks, muscle groups, and subject populations. Although, most tDCS studies on lower leg muscle strength have focused on the acute effects of a single tDCS application, to the best of our knowledge, no study has examined how lower extremity strength training combined with repeated sessions of tDCS affects lower leg muscle strength. This type of investigation has strong clinical implications for the application of tDCS in rehabilitation for patients with lower leg muscle weakness.

Thus, to examine whether anodal tDCS can enhance the effects of lower extremity muscle strength training, the present study simultaneously applied anodal tDCS and lower extremity muscle strength training to healthy individuals and evaluated their effects on lower extremity muscle strength.

Continue —> Frontiers | Transcranial Direct Current Stimulation Does Not Affect Lower Extremity Muscle Strength Training in Healthy Individuals: A Triple-Blind, Sham-Controlled Study | Perception Science

Figure 1. Experimental setup of the muscle strength training and torque assessment.

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[Abstract] Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study

Highlights

  • The effect of sit-to-stand training combined with TENS was evaluated in stroke patients with spastic plantar flexor.
  • TENS followed by sit-to-stand training may improve spasticity, muscle strength and balance.
  • Clinician should consider TENS application prior to sit to stand training for stroke patients with spastic plantar flexor.

Abstract

Sit-to-stand is a fundamental movement of human being for performing mobility and independent activity. However, Stroke people symptoms experience difficulty in conducting the sit-to-stand due to paralysis and especially ankle spasticity. Recently, transcutaneous electrical- stimulation (TENS) is used to reduce pain but also to manage spasticity.

The purpose of this study was to determine

  1. whether TENS would lead to ankle spasticity reduction and (
  2. whether sit-to-stand training combined with TENS would improve spasticity, muscle strength and balance ability in stroke patients.

Forty-stroke patients were recruited and were randomly divided into two groups: TENS group (n = 20) and sham group (n = 20). All participants underwent 30-sessions of sit-to-stand training (for 15-minutes, five-times per week for 6-weeks). Prior to each training session, 30-minutes of TENS over the peroneal nerve was given in TENS group, whereas sham group received non-electrically stimulated TENS for the same amount of time. Composite-Spasticity-Score was used to assess spasticity level of ankle plantar-flexors. Isometric strength in the extensor of hip, knee and ankle were measured by handhelddynamometer. Postural-sway distance was measured using a force platform.

The spasticity score in the TENS group (2.6 ± 0.8) improved significantly greater than the sham group (0.7 ± 0.8, p < 0.05). The muscle strength of hip extensor in the TENS group (2.7 ± 1.1 kg) was significantly higher than the sham group (1.0 ± 0.8 kg, p < 0.05). Significant improvement in postural-sway was observed in the TENS group compared to the sham group (p < 0.05).

Thus, sit-to-stand training combined with TENS may be used to improve the spasticity, balance function and muscle strength in stroke patients.

Source: Effects of sit-to-stand training combined with transcutaneous electrical stimulation on spasticity, muscle strength and balance ability in patients with stroke: a randomized controlled study – Gait & Posture

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[DOCTORAL DISSERTATION] Upper extremity disability after stroke. Psychometric properties of outcome measures and perceived ability to perform daily hand activities – Full Text

LUND UNIVERSITY

Department of Health Sciences, Physiotherapy, Lund University

DOCTORAL DISSERTATION

Date of issue 2016-10-08

Author(s) Elisabeth Ekstrand

Abstract

Disability of the upper extremity is common after stroke. To be able to evaluate recovery and effects of interventions there is a need for stable and precise outcome measures. In order to design and target efficient rehabilitation interventions it is important to know which factors that affect the ability to perform daily hand activities. At the time when the studies in this thesis were planned there was limited knowledge of the psychometric properties of outcome measures for persons with mild to moderate impairments of the upper extremity after stroke. There was also a lack of knowledge of which daily hand activities these persons perceive difficult to perform and which factors are associated with the performance.

The overall aim of this thesis was to evaluate the psychometric properties of outcome measures for upper extremity after stroke, and to describe which daily hand activities persons with mild to moderate impairments in upper extremity after stroke perceive difficult to perform and identify associated factors with their performance.

In paper I – IV, between 43 and 45 participants were included. Muscle strength in the upper extremity, somatosensation (active touch), dexterity and self-perceived ability to perform daily hand activities were assessed twice, one to two weeks apart. In paper V, 75 participants were included and the evaluated measures of the upper extremity were used together with other stroke specific outcomes to cover important aspects of functioning and disability according to the International Classification of Functioning, Disability and Health (ICF). Test-retest analyses for continuous data were made with the Intraclass Correlation Coefficient (ICC), the Change in Mean, the Standard Error of Measurement (SEM) and the Smallest Real Difference (SRD) (Paper I, III and IV). For ordinal data the Kappa coefficient and the Elisabeth Svensson rank-invariant method were used (Paper II and III). For analyses of convergent validity the Spearman’s correlation coefficient (rho) was calculated (Paper III). The ability to perform daily hand activities and the associations with potential factors were evaluated by univariate and multivariate linear regression models (Study V).

The results showed that outcome measures for isometric and isokinetic muscle strength, active touch, dexterity and self-perceived daily hand activities have high test-retest agreements and can be recommended for persons with mild to moderate impairments in the upper extremity after stroke (Paper I to IV). Isometric strength measurements had lower measurement errors than isokinetic measurements and might be preferred (Paper I). The outcomes of dexterity showed learning effects (Paper III) and the ratings of perceived daily hand activities (Paper IV) had relatively high random measurement errors which must be taken into account when recovery and effects of interventions are evaluated. The three evaluated dexterity measures were partly related and can complement each other (Paper IV). Daily hand activities that require bimanual dexterity were perceived most difficult to perform, and dexterity and participation were the strongest contributing factors for performing daily hand activities after stroke (Paper V).

In conclusion, this thesis has shown that outcome measures assessing functioning and disability of upper extremity after stroke are reliable and can be used in clinical settings and research. To increase the ability to perform daily hand activities, dexterity and perceived participation, in particular, should be considered in the assessments, goal-settings and rehabilitation after stroke.

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[Abstract] Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study – Archives of Physical Medicine and Rehabilitation

Abstract

Objective

To measure the strength of the major muscle groups of the affected and intact lower limbs in people with stroke compared with age-matched controls.

Design

Cross-sectional study.

Setting

University laboratory.

Participants

Ambulatory stroke survivors (n=60; mean age, 69±11y), who had had a stroke between 1 and 6 years previously, and age-matched controls (n=35; mean age, 65±9y) (N=95).

Interventions

Not applicable.

Main Outcome Measures

The maximum isometric strength of 12 muscle groups (hip flexors and extensors, hip adductors and abductors, hip internal rotators and external rotators, knee flexors and extensors, ankle dorsiflexors and plantarflexors, ankle invertors and evertors) of both lower limbs was measured using handheld dynamometry. All strength measurements were taken in standardized positions by 1 rater.

Results

The affected lower limb of the participants with stroke was significantly weaker than that of the control participants for all muscle groups (P<.01). Strength (adjusted for age, sex, and body weight) was 48% (range, 34%–62%) of that of the control participants. The most severely affected muscle groups were hip extensors (34% of controls), ankle dorsiflexors (35%), and hip adductors (38%), and the least severely affected muscle groups were ankle invertors (62%), ankle plantarflexors (57%), and hip flexors (55%). The intact lower limb of the participants with stroke was significantly weaker than that of the control participants for all muscle groups (P<.05) except for ankle invertors (P=.25). Strength (adjusted for age, sex, and body weight) was 66% (range, 44%–91%) of that of the control participants. The most severely affected muscle groups were hip extensors (44% of controls), ankle dorsiflexors (52%), and knee flexors (54%).

Conclusions

Ambulatory people with chronic stroke have a marked loss of strength in most of the major muscle groups of both lower limbs compared with age-matched controls.

Source: Lower Limb Strength Is Significantly Impaired in All Muscle Groups in Ambulatory People With Chronic Stroke: A Cross-Sectional Study – Archives of Physical Medicine and Rehabilitation

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[Abstract] Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. – PubMed

Abstract

BACKGROUND:

Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADLs) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength and cognitive abilities (including spatial neglect) after stroke, but a possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve ADL performance, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.

OBJECTIVES:

To assess the effects of tDCS on ADLs, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.

SEARCH METHODS:

We searched the Cochrane Stroke Group Trials Register (February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2015, Issue 2), MEDLINE (1948 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), AMED (1985 to February 2015), Science Citation Index (1899 to February 2015) and four additional databases. In an effort to identify further published, unpublished and ongoing trials, we searched trials registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers.

SELECTION CRITERIA:

This is the update of an existing review. In the previous version of this review we focused on the effects of tDCS on ADLs and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADLs, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention.

DATA COLLECTION AND ANALYSIS:

Two review authors independently assessed trial quality and risk of bias (JM and MP) and extracted data (BE and JM). If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports.

MAIN RESULTS:

We included 32 studies involving a total of 748 participants aged above 18 with acute, postacute or chronic ischaemic or haemorrhagic stroke. We also identified 55 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes.We found nine studies with 396 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADLs after stroke. We found evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.24, 95% confidence interval (CI) 0.03 to 0.44; inverse variance method with random-effects model; moderate quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADLs at the end of follow-up, and found improved ADL performance (SMD 0.31, 95% CI 0.01 to 0.62; inverse variance method with random-effects model; moderate quality evidence). However, the results did not persist in a sensitivity analysis including only trials of good methodological quality.One of our secondary outcome measures was upper extremity function: 12 trials with a total of 431 participants measured upper extremity function at the end of the intervention period, revealing no evidence of an effect in favour of tDCS (SMD 0.01, 95% CI -0.48 to 0.50 for studies presenting absolute values (low quality evidence) and SMD 0.32, 95% CI -0.51 to 1.15 (low quality evidence) for studies presenting change values; inverse variance method with random-effects model). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified four studies with a total of 187 participants (absolute values) that showed no evidence of an effect (SMD 0.01, 95% CI -0.48 to 0.50; inverse variance method with random-effects model; low quality evidence). Ten studies with 313 participants reported outcome data for muscle strength at the end of the intervention period, but in the corresponding meta-analysis there was no evidence of an effect. Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect.In six of 23 studies (26%), dropouts, adverse events or deaths that occurred during the intervention period were reported, and the proportions of dropouts and adverse events were comparable between groups (risk difference (RD) 0.01, 95% CI -0.02 to 0.03; Mantel-Haenszel method with random-effects model; low quality evidence; analysis based only on studies that reported either on dropouts, or on adverse events, or on both). However, this effect may be underestimated due to reporting bias.

AUTHORS’ CONCLUSIONS:

At the moment, evidence of very low to moderate quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance after stroke. However, there are many ongoing randomised trials that could change the quality of evidence in the future. Future studies should particularly engage those who may benefit most from tDCS after stroke and in the effects of tDCS on upper and lower limb function, muscle strength and cognitive abilities (including spatial neglect). Dropouts and adverse events should be routinely monitored and presented as secondary outcomes. They should also address methodological issues by adhering to the Consolidated Standards of Reporting Trials (CONSORT) statement.

Source: Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after st… – PubMed – NCBI

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