Carin Willén

Kinematic Variables Quantifying Upper-Extremity Performance After Stroke During Reaching and Drinking From a Glass

Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study groups. The number of movement units, total movement time, and peak angular velocity of elbow discriminated best between healthy participants and those with stroke as well as between those with moderate (Fugl-Meyer scores of 39-57) versus mild (Fugl-Meyer scores of 58-64) arm impairment. In addition, the measures of compensatory trunk and arm movements discriminated between those with moderate and mild stroke impairment. Conclusion. Kinematic analysis in this study identified a set of movement variables during a functional task that may serve as an objective assessment of upper-extremity motor performance in persons who can complete a task, such as reaching and drinking, after stroke.

Pain, physical activity, and disability in individuals with late effects of polio

OBJECTIVE The aim of this study was to provide a description of pain and its relationship to the effects of polio, physical activity, and disability. DESIGN Assessment instruments used were: a pain questionnaire, a pain drawing, a visual analogue scale (VAS), a 30-m walk indoors, isokinetic muscle strength, serum creatine kinase concentration, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP). SETTING A university hospital department. SUBJECTS Thirty-two consecutive individuals with late effects of polio. RESULTS More than 50% of the individuals had pain every day, mostly during physical activity. The mean VAS score for daily pain intensity was 55mm, range 0 to 93mm. In the lower limbs cramping pain was the most common pain characteristic in both polio-affected and non-polio-affected limbs. In the upper limbs and in the trunk, aching pain was the most common pain characteristic, especially in the polio-affected areas. The degree of muscle weakness had no correlation to pain experience. The walking test demonstrated a relatively small difference between spontaneous and maximal walking speed. The NHP questionnaire demonstrated that all six dimensions (energy, pain, physical mobility, sleep, emotional reactions, and social isolation) were affected. The dimensions pain and physical mobility both strongly correlated with energy. CONCLUSIONS There is a relationship between physical activity in daily life and experience of pain. In many postpolio individuals who experience a high level of pain, spontaneous and maximal walking speed are approximately the same. It is strongly recommended that individuals with late effects of polio, experiencing aching and especially cramping pain, modify their level of physical activity.

Movement Kinematics During a Drinking Task Are Associated With the Activity Capacity Level After Stroke

Background. Kinematic analysis is a powerful method for an objective assessment of movements and is increasingly used as an outcome measure after stroke. Little is known about how the actual movement performance measured with kinematics is related to the common traditional assessment scales. The aim of this study was to determine the relationships between movement kinematics from a drinking task and the impairment or activity limitation level after stroke. Methods. Kinematic analysis of movement performance in a drinking task was used to measure movement time, smoothness, and angular velocity of elbow and trunk displacement (TD) in 30 individuals with stroke. Sensorimotor impairment was assessed with the Fugl-Meyer Assessment (FMA), activity capacity limitation with the Action Research Arm Test (ARAT), and self-perceived activity difficulties with the ABILHAND questionnaire. Results. Backward multiple regression revealed that the movement smoothness (similarly to movement time) and TD together explain 67% of the total variance in ARAT. Both variables uniquely contributed 37% and 11%, respectively. The TD alone explained 20% of the variance in the FMA, and movement smoothness explained 6% of the variance in the ABILHAND. Conclusions. The kinematic movement performance measures obtained during a drinking task are more strongly associated with activity capacity than with impairment. The movement smoothness and time, possibly together with compensatory movement of the trunk, are valid measures of activity capacity and can be considered as key variables in the evaluation of upper-extremity function after stroke. This increased knowledge is of great value for better interpretation and application of kinematic data in clinical studies.

DISABILITY IN A 4-YEAR FOLLOW-UP STUDY OF PEOPLE WITH POST- POLIO SYNDROME*

OBJECTIVE To evaluate changes over time in a clinically based cohort of individuals with post-polio syndrome. DESIGN A prospective longitudinal study. SUBJECTS A total of 106 individuals with poliomyelitis sequelae were included in the study. They were self-referred or had been referred to the post-polio clinic. After 4 years subjects were called for a follow-up and underwent the same measurements as at the initial assessment. METHODS The following measurements were conducted at both the initial assessment, and the follow-up: questionnaires including Nottingham Health Profile, muscle strength and walking speed. RESULTS Minor changes in disability during a 4-year period were shown. A significant reduction in muscle strength was only seen for 60 degrees flexion in the left leg and for right and left dorsal flexion. No change could be seen in the total Nottingham Health Profile score. CONCLUSION The minor changes in disability found in this study are an indication that we still do not know which subjects are at risk for deterioration. It is difficult to say whether the small changes over time shown in this study are associated with support from the polio clinic or are an expression of the natural history of the syndrome. However, it is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity.

Group training in a pool causes ripples on the water: experiences by persons with late effects of polio.

The purpose of the present qualitative study was to describe how persons with late effects of polio experienced dynamic exercise in water in a group. Semi-structured interviews with 15 participants were carried out and analysed according to the phenomenographic approach. The results showed great variation in the way the participants experienced the group training. Fourteen different categories appeared focusing on three different aspects: the self, the training situation and the world around. It appears that the experienced effect of group training in water goes beyond improving physical functions.

Responsiveness of upper extremity kinematic measures and clinical improvement during the first three months after stroke.

Background. Kinematic movement analysis is increasingly used as an outcome measure in evaluation of upper extremity function after stroke. Little is known, however, about what observed longitudinal changes in kinematics mean in the context of an individual’s functioning. In this study, the responsiveness and expected change in kinematic measures associated with clinically meaningful improvement in the upper extremity were evaluated. Methods. Kinematic movement analysis of a drinking task and Action Research Arm Test (ARAT) were performed early (9 days poststroke) and at 3 months after stroke in 51 subjects. The receiver-operating characteristic curve and linear regression analyses were used to evaluate responsiveness of kinematic parameters. Results. Movement time, smoothness, and trunk displacement discriminated those subjects demonstrating clinically meaningful improvements. Significant associations of 31% to 36% were found between the change in ARAT and kinematic measures. A real clinical improvement in kinematics lies in the range of 2.5 to 5 seconds, 3 to 7 units, and 2 to 5 cm in movement time, smoothness, and trunk displacement, respectively. Conclusions. All kinematic measures reported in this study are responsive measures for capturing improvements in the upper extremity during the first 3 months after stroke. Approximate estimates for the expected change in kinematics associated with clinically meaningful improvement in upper extremity activity capacity illustrate the usefulness of the linear regression analysis for assessing responsiveness. This knowledge facilitates the selection of kinematic measures for clinical and movement analysis research as well as for technology-based devices.

Is walking endurance associated with activity and participation late after stroke

Purpose. After stroke, impaired walking ability may affect activity and participation. The aim was to investigate whether self-reported activity and participation were associated with walking endurance late after stroke. Method. A non-randomised sample of 31 persons with a mean age of 59.7 years and time since stroke of 7–10 years was studied. Walking endurance was measured by the 6-minute walk test (6MWT). Self-reported activity and participation were measured by the Physical Activity Scale for the Elderly and the Stroke Impact Scale. Relationships were analysed with linear regression. Results. A regression model including activities of daily living and 6MWT explained 44%%, mobility and 6MWT explained 25%% and a model including physical activity level and 6MWT explained 21%% of the variation in activity. Regarding participation, the explanatory level of the model of participation and 6MWT was 30%%. Conclusions. Walking distance several years after stroke was partly associated with self-reported difficulties in activity and participation.

Relationship between walking function and 1-legged bicycling test in subjects in the later stage post-stroke.

OBJECTIVE The aim of the present study was to examine the correlation between 1-legged bicycling and the 6-minute walk test (6MWT) in subjects post-stroke. A further aim was to analyse the relationship between specific stroke impairment and walking endurance. PARTICIPANTS Thirty-four subjects (mean age 60 (standard deviation (SD) 4.1) years; mean time post-stroke 62 (SD 33) months) with stroke at least 6 months earlier were tested. METHODS Subjects were evaluated using the 6MWT (distance, heart rate, systolic blood pressure), 1-legged bicycling (VO2peak, maximal workload (Wmax), heart rate, systolic blood pressure, total exercise time), Fugl-Meyer motor function scale for the lower extremity and Berg Balance Scale. Correlational analyses were used to evaluate the relationships between variables. RESULTS There was a low correlation between 6MWT and VO2peak (rs=0.39) and a moderate correlation with Wmax (rs=0.64) and total exercise time (rs=0.58) (p<0.001) during 1-legged bicycling test for the paretic leg. However, no significant correlation was found in the non-paretic leg. Motor function for the lower extremity and Berg Balance Scale showed a high (rs=0.72) and moderate (rs=0.68) correlation, respectively, with the 6MWT. CONCLUSIONS The 6MWT is influenced by motor function and balance as well as cardiorespiratory fitness. Heart rate and systolic blood pressure indicate cardiovascular stress, but the 6MWT cannot be used alone to evaluate fitness in subjects with stroke in the later stages.

Physical Activity and Health-Related Quality of Life Among Community Dwelling Elderly.

Background Physical activity (PA) and health-related quality of life (HRQoL) are important factors for optimal health in the elderly. Studying the association between PA and HRQoL is becoming more essential as the number of elderly people increases worldwide. This study assesses the association between PA and HRQoL among community dwelling elderly above 60 years old. Methods The study included 115 women and 61 men (mean age: 68.15 ± 6.74 years) recruited from the community and from public centers for the elderly. Data were collected using a background characteristics questionnaire (BCQ), a physical activity socio-cultural adapted questionnaire (PA-SCAQ), and the EuroQuol-5Dimensions-5Levels (EQ-5D-5L) questionnaire. Between groups, comparisons were based on the PA-SCAQ by dividing the participants into three PA groups: low (n = 74), moderate (n = 85), and high (n = 17). Kruskal-Wallis tests were performed on the ordinal variables of the three PA groups to determine differences between the groups according to categorical variables such as gender, body mass index (BMI), and the prevalence of comorbid conditions. Mann-Whitney U tests were performed on the ordinal variables of the EuroQuol-5Dimensions (EQ-5D), and the independent sample t-test was performed on the EQ visual analogue scale (EQ-VAS). Spearman’s rank correlation coefficient was used to examine the correlation between the EQ-5D and level of PA. Results Values in all dimensions of HRQoL were significantly higher (P < 0.05) in the moderate and high PA groups compared with the low PA group. Significant correlations were recorded between the five dimensions of HRQoL and the level of PA (P < 0.001). The low PA group showed higher prevalence of hypertension (64%, P < 0.001) and diabetes (50%, P < 0.001). Conclusion There were strong associations between higher levels of PA and all dimensions of HRQoL. Therefore, adopting a PA lifestyle may contribute to better HRQoL among community dwelling elderly above 60 years old.

Physical Activity, Ambulation, and Motor Impairment Late after Stroke

Objective. To assess walking capacity and physical activity using clinical measures and to explore their relationships with motor impairment late after stroke. Subjects. A nonrandomised sample of 22 men and 9 women with a mean age of 60 years, 7–10 years after stroke. Methods. Fugl-Meyer Assessment, maximum walking speed, 6 min walk test, perceived exertion, and heart rate were measured, and the Physiological Cost Index was calculated. Physical activity was reported using The Physical Activity Scale for the Elderly. Results. Mean (SD) 6 min walking distance was 352 (±136) m, and Physiological Cost Index was 0.60 (±0.41). Self-reported physical activity was 70% of the reference. Motor impairment correlated with walking capacity but not with the physical activity level. Conclusion. It may be essential to enhance physical activity even late after stroke since in fairly young subjects both walking capacity and the physical activity level were lower than the reference.