Hiroki Kubo

Changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors

Background:Loss of skeletal muscle mass is one of the main reasons for disability in patients with stroke. However, lower leg muscle wasting has not been studied in acute stroke patients. Objective:To investigate the changes in quadriceps muscle thickness in acute non-ambulatory stroke survivors. Methods:A total of 16 consecutive acute non-ambulatory stroke survivors who were in acute inpatient rehabilitation, with a mean age of 72.1 years, were included in the study. Quadriceps muscle thickness was examined in their paretic and non-paretic limbs within the first week from admission (first week), 1 week after the first examination (second week), and 1 week after the second week examination (third week) using ultrasonography. Results:Quadriceps muscle thickness in the paretic limb decreased every week (mean% difference between the first and second weeks, 12.8, 95% confidence interval (CI) 5.3–20.2%; mean% difference between the second and third weeks, 10.1, 95% CI 5.2–14.9%). Quadriceps muscle thickness in the non-paretic limb was lower in the second and third weeks than the first week, but there was no difference between the second and third weeks (mean% difference between the first and second weeks, 9.3, 95% CI 2.5–16.1%; mean% difference between the second and third weeks, 5.3, 95% CI − 1.6 to 12.1%). Conclusion:Quadriceps muscle thickness decreased in acute non-ambulatory stroke survivors not only in the paretic limb but also in the non-paretic limb, particularly during the period from admission to the second week.

Promoting physical activity in hospitalized patients with mild ischemic stroke: a pilot study

Abstract Background: Patients with acute stroke spend most of their hospital day inactive. However, a method to promote physical activity (PA) in stroke has not been established. Objective: To evaluate the effectiveness of promoting PA by enhancing self-efficacy in hospitalized patients with mild ischemic stroke. Design: Pre–post interventional study. Methods: Hospitalized patients with mild ischemic stroke who could walk without assistance were recruited. We measured the daily number of steps taken as the index of daily hospitalized PA using an accelerometer. At the baseline measurement, patients did not receive accelerometer-based feedback. To promote hospitalized PA, a physical therapist provided instruction on the self-monitoring approach and discussed PA targets, encouraged the patients to walk more, and instructed them on the importance of PA after stroke. We also measured self-efficacy for PA using an assessment tool at the baseline and during the intervention. Results: Twenty-two patients (62.5 years old, 68.2% men) were included. PA during the intervention was higher than that at the baseline measurement (5709.4 ± 2236.1 vs. 2813.9 ± 1511.9 steps/day, p < 0.001). Self-efficacy for PA during the intervention was also higher than that at the baseline measurement (76.4 ± 18.8 vs. 58.9 ± 29.0 points, p < 0.001). Conclusions: Promoting PA by enhancing self-efficacy may increase PA and self-efficacy for PA in hospitalized patients with mild ischemic stroke. The present results might provide new strategies of PA promotion in these hospitalized patients.

Changes in Quadriceps Muscle Thickness, Disease Severity, Nutritional Status, and C-Reactive Protein after Acute Stroke

BACKGROUND Lower leg muscle wasting is common in stroke patients; however, patient characteristics in the acute phase are rarely studied. This study aimed to examine the relationship between changes in quadriceps muscle thickness and disease severity, nutritional status, and C-reactive protein (CRP) levels after acute stroke. METHODS Thirty-one consecutive patients with acute intracerebral hemorrhage or ischemic stroke had quadriceps muscle thickness measured in the paretic and nonparetic limbs within 1 week after admission (first week) and 2 weeks after the first examination (last week) using ultrasonography. We also determined the relationship between the percentage change in muscle thickness and disease severity, nutritional status, and CRP levels on admission. RESULTS There was a significant correlation between changes in muscle thickness for both paretic and nonparetic sides and National Institutes of Health Stroke Scale (NIHSS) scores (paretic limb: r = -.46, P = .01; nonparetic limb: r = -.54, P = .002, respectively); however, there was no significant correlation with nutritional status on admission. Quadriceps muscle thickness was reduced more in the CRP-positive (≥.3 mg/dL) patients than in the CRP-negative (<.3 mg/dL) patients in the nonparetic limb (positive: -21.4 ± 12.1, negative: -11.4 ± 16.4%; P = .039), but not in the paretic limb (positive: -23.4 ± 9.0, negative: -19.1 ± 15.7; P = .27). CONCLUSIONS A high NIHSS score and a positive CRP on admission were both significantly correlated with decreased quadriceps muscle thickness after acute stroke. Nutritional status on admission was not correlated with changes in quadriceps muscle thickness for these patients.

Effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke: a randomized controlled trial:

Objective: To evaluate the effect of accelerometer-based feedback on physical activity in hospitalized patients with ischemic stroke. Design: Randomized controlled trial. Setting: Acute care hospital. Subjects: A total of 55 patients with ischemic stroke who could walk without assistance were randomly assigned to the intervention group (n = 27) or the control group (n = 28). Interventions: At the baseline measurement, patients did not receive accelerometer-based feedback. At follow-up, a physical therapist provided instruction on accelerometer-based feedback, discussed physical activity targets and encouraged the patients to walk more until discharge. Main measures: The average daily number of steps taken was used as the index of daily hospitalized physical activity. Results: The study sample consisted of 48 patients, of whom 23 patients comprised the intervention group and 25 patients comprised the control group. Although there were no significant differences in physical activity values between the two groups at the baseline measurement, the values in the intervention group at follow-up were significantly higher than those in the control group (5180.5 ± 2314.9 vs. 3113.6 ± 1150.9 steps/day, P = 0.0003). The effect size of physical activity values (Cohen’s d = 1.15) at follow-up was large between the two groups. Conclusion: Exercise training combined with accelerometer-based feedback effectively increased physical activity in hospitalized patients with ischemic stroke.

Efficacy of neuromuscular electrical stimulation for preventing quadriceps muscle wasting in patients with moderate or severe acute stroke: A pilot study

BACKGROUND Stroke-related muscle wasting is one of the factors leading to long-term disability and functional dependency. No study has reported an effective therapeutic intervention for such muscle wasting. OBJECTIVE The purpose of this study was to investigate the effects of neuromuscular electrical stimulation (NMES) on quadriceps muscle mass preservation in patients with acute moderate or severe stroke by using ultrasonography (US). METHODS Twenty patients with acute, moderate, or severe stroke (age: 68±11 years) were divided into usual care group (control group) and intervention groups (NMES group), respectively. Patients in the NMES group underwent NMES treatment for bilateral quadriceps muscles for 2 weeks in addition to the usual care. Quadriceps muscle thickness was measured on admission and 2 weeks after the first measurement. RESULTS The quadriceps muscle thickness on the paretic and non-paretic sides in the NMES group (-12.4% ±12.7%, -5.5% ±15.3%, respectively) significantly decreased to a lesser degree than that in the control group (-29.5% ±12.1%, P = 0.004; and -22.0% ±16.8%, P = 0.04, respectively). CONCLUSIONS NEMS seemed to have preserved the quadriceps muscle mass in patients with moderate or severe acute stroke.

Quadriceps muscle thickness changes in patients with aneurysmal subarachnoid hemorrhage during the acute phase

Abstract Background Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition that often leads to severe disability in relatively young and healthy people. This disability is physical in many aSAH survivors, so muscle dysfunction may be an important factor in the functional level of these patients. Thus, measuring muscle thickness represents a suitable method for determining muscle function in patients with acute aSAH, because the disordered consciousness often experienced during the acute phase causes active movement to be difficult for these patients. Objectives We investigated changes in quadriceps muscle thickness in patients with aneurysmal subarachnoid hemorrhage to determine whether muscle dysfunction during the acute phase relates to (or predicts) the outcome of aSAH. Methods Seventeen patients with aSAH (mean age = 66 ± 11, men/women = 4/13) were enrolled, and their quadriceps muscle thickness measured ultrasonographically upon admission and again 2 weeks later. Results Quadriceps muscle thickness significantly decreased from admission (mean = 3.00 ± 0.72 cm) to the second measurement (2.67 ± 0.74 cm, p = 0.001). The relative differences in quadriceps muscle thickness were correlated with the Hunt and Hess grade (r = −0.72, p = 0.001) and the modified Rankin Scale score at 90 days (r = −0.78, p = 0.0002). Conclusions Our results indicate that quadriceps muscle thickness decreases in patients with acute aneurysmal subarachnoid hemorrhage, particularly in patients with poor Hunt and Hess grade or marked disability.

Safety and Feasibility of the 6-Minute Walk Test in Patients with Acute Stroke

BACKGROUND Our objective was to investigate the safety and feasibility of the 6-minute walk test in patients with acute stroke. MATERIALS AND METHODS Consecutive patients with acute stroke, admitted to the Itami Kosei Neurosurgical Hospital from September 2016 to April 2017 were enrolled. Walking capacity was assessed by a physical therapist using the 6-minute walk test in 94 patients with acute stroke within 14 days of hospital admission. The primary outcomes were safety (i.e., the prevalence of new adverse events during and after the test) and feasibility (i.e., test completion rate) of the 6-minute walk test. RESULTS The 6-minute walk test was performed for a mean duration of 5.1 days (standard deviation, 2.6 days) after hospital admission. Seventy patients (74.5%) could walk without standby assistance or a walking aid, and 24 patients (25.5%) could walk without standby assistance but with a walking aid. The average distance walked by patients during the 6-minute walk test was 331 m (standard deviation, 107.2 m). Adverse events following the 6-minute walk test occurred in 6 patients (6.4%) and included stroke progression, stroke recurrence, seizures, and neurological deterioration. Heart rate increase (>120 beats/min) occurred in 3 patients (3.2%) during the test. Lastly, 6 patients (6.4%) were unable to complete the 6-minute walk test. CONCLUSIONS Although performance in the 6-minute walk test was decreased in patients with acute stroke, the test itself appears to be safe and feasible in this patient population.

Heart Rate Variability During Early Mobilization in Patients with Acute Ischemic Stroke

Autonomic dysfunction is one of the predictors of poor outcome in patients with acute ischemic stroke. We compared the heart rate variability (HRV) during early mobilization in patients with or without neurological deterioration (ND). We enrolled 7 acute ischemic patients with ND and 14 without ND and measured their HRV in the rest and mobilization by electrocardiography. There was a significant difference in sympathetic nervous activity during mobilization between the 2 groups. However, no significant differences in blood pressure, heart rate, and parasympathetic nerve activity were observed. In patients with acute ischemic stroke, it is likely that the increase in sympathetic nervous activity during mobilization is associated with ND.