Patricia S. Pohl

Gains in Distance Walking in a 3-Month Follow-Up Poststroke: What Changes?:

Statement of Problem. Distance walking remains compromised for many adults poststroke. The purpose of this study was to examine if the amelioration of strokerelated neuromuscular impairments, improved cardiovascular fitness, or better balance contributed to gains in distance walking. Method of Study. The authors gathered baseline data of 92 adults at an average of 75 days poststroke and again 3 months later. Participants performed a bicycle ergometry stress test, a 6-min walk, and a Fugl-Meyer assessment for motor control, strength, and balance testing. The gain in walk distance was modeled using multiple regression with the variables of gains in peak VO2 lower limb control, plantar flexion strength, and balance. Separate analyses were done for poor performers, that is, participants who walked less than the median distance (213 m) at baseline and good performers, that is, participants who walked more than 213 m. Results. For poor performers, the gain in balance was the only significant predictor of the gain in distance walking and accounted for 16% of the variance. For good performers, gains in peak VO2 and the lower limb Fugl-Meyer score were significant predictors and accounted for 28% of the variance. Discussion. These results suggest that rehabilitation efforts to improve distance walking should focus on different factors depending on initial distance walked.

Ipsilateral deficits of targeted movements after stroke

OBJECTIVE To test the hypotheses that targeted movements of both the ipsilateral and the contralateral extremities of stroke survivors would be prolonged compared with those from a control group without stroke, and that the ipsilateral deficit would occur in movements toward small, but not large, targets. DESIGN Descriptive study. SETTING Motor performance laboratory. PARTICIPANTS Convenience sample of right-handed individuals including 10 who were more than 6 months poststroke with Fugl-Meyer Motor Assessment scores greater than 75% for the upper (UEs) and lower (LEs) extremities, and a comparison group of 20 age-matched adults without stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The average time required for the stylus, held with the hand or strapped to the foot, to travel from leaving 1 target to contacting the second target (ie, movement time) and the average time the stylus rested on the target (ie, dwell time). RESULTS Regardless of target size, movement and dwell times for both UEs of the stroke group were prolonged compared with those of the comparison group. Regardless of target size, dwell time for both LEs of the stroke group was prolonged compared with that of the comparison group. CONCLUSIONS After stroke, the ipsilateral extremities may show subtle deficits in targeted movements.

Reliability of lower extremity isokinetic strength testing in adults with stroke

Objective: To evaluate the reliability of isokinetic strength testing of knee flexion and extension at 60 degrees per second, and ankle plantar flexion and dorsiflexion at 30 degrees per second in adults with stroke. Design: Test–retest using intraclass correlation coefficients (ICC). Setting: Human performance laboratory. Subjects: Ten adults post stroke with a mean age of 64 years (five males) and 10 adults without neurological injury with a mean age of 69 years (three males) who served as controls. Main outcome measures: Peak torque and average torque. Results: The reliability of strength of the less-affected lower extremity was high with values ranging from 0.75 to 0.97. Knee extension, ankle plantar flexion and the peak torque of dorsiflexion were reliable for the affected limb, ranging from 0.80 to 0.90. In contrast, affected knee flexion was not reliable with values of 0.48 and 0.44 for peak torque and average peak torque respectively. Conclusions: Isokinetic knee and ankle strength of the less-affected limb are reliable. Isokinetic strength of the affected lower extremity is also reliable with the noted exception of knee flexion.

The Role of Sensory Processing in the Everyday Lives of Older Adults

This study investigated whether there are age-related differences in sensory processing within daily life. Participants included 404 community-dwelling adults divided into three age groups: 19 to 34 years old (127 individuals), 35 to 64 years old (126 individuals), and 65 years and older (151 individuals). Each participant completed the Adolescent/Adult Sensory Profile. There was a difference in sensory processing between the three groups (p = .000), with the older adults noticing sensory input less than the young and middle aged adults (p = .002 for both groups). Both middle aged and older adults engaged in less sensory seeking behaviors than did young adults (p = .012 and p = .000, respectively). In an additional analysis, the older group was subdivided into four age groups (65 to 69 years, 70 to 74 years, 75 to 79 years, and 80 years and older). There was an age-related difference between the four groups (p = .000). Those 75 to 79 years old and those 80 years and older noticed sensory input less than did those younger than 70 years (p = .002 and p = .001, respectively). Those 80 years and older were also less apt to seek sensory experiences than were those younger than 70 years (p = .011). The authors propose hypotheses about the meaning of these findings and provide recommendations for the application of this knowledge to support older adults to age in place successfully.

Revealing Language Deficits Following Stroke: The Cost of Doing Two Things at Once

ABSTRACT The costs of doing two things were assessed for a group of healthy older adults and older adults who were tested at least 6 months after a stroke. A baseline language sample was compared to language samples collected while the participants were performing concurrent motor tasks or selective ignoring tasks. Whereas the healthy older adults showed few costs due to the concurrent task demands, the language samples from the stroke survivors were disrupted by the demands of doing two things at once. The dual task measures reveal long-lasting effects of strokes that were not evident when stroke survivors were assessed using standard clinical tools.

Upper Extremity Control in Adults Post Stroke with Mild Residual Impairment

Motor control deficits in the upper extremity (UE) ipsilateral to the side of brain damage persist after stroke, but it is not known if the presence of these deficits is re lated to impairment of the contralateral UE. The purpose of this study was to inves tigate whether motor deficits are present in the ipsilateral UE when contralateral UE impairment is mild in adults with chronic stroke. Right-handed adults (10 controls, 10 right stroke, 10 left stroke) performed rapid continuous aiming movements to small and large targets. Using kinematic analysis, temporal measures of the movement were defined, including movement time (MT) and the three components of MT: acceler ation, deceleration, and dwell time (i.e., time on target). Participants with right stroke had prolonged MT only with the left UE, primarily due to longer dwell times. Partic ipants with left stroke had prolonged MT with both UEs as a result of longer dwell times. The results indicate that control deficits of the ipsilateral UE are evident in individuals with left but not right brain damage who have minimal impairment of the contralateral UE. These findings are consistent with the role of the left hemisphere in the control of both UEs. Key Words: Cerebrovascular disorders—Psychomotor per formance—Hemispheric asymmetry.

Single Limb Exercise: Pilot Study of Physiological and Functional Responses to Forced Use of the Hemiparetic Lower Extremity

Abstract Purpose: Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. Methods: Twelve participants (5 male) with a mean age of 60.6 ± 14.5 years and 69.1 ± 82.2 months post stroke participated in the training intervention. All participants performed SLE using the hemiparetic leg three times a week for 4 weeks. The nonhemiparetic limb served as the control limb and did not engage in SLE. Peak oxygen uptake (VO2 peak) and oxygen uptake (VO2) were measured at baseline and post intervention in all 12 participants. At pre and post intervention, gait velocity was assessed in a subset of participants (n = 7) using the 10-m fast-walk test. Results: After the 4-week SLE training intervention, significant improvements were found for VO2 during submaximal work effort (P = .009) and gait velocity (n = 7) (P = .001). Peak oxygen uptake did not increase (P = .41) after the training intervention. Conclusion: These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.

Anticipatory postural adjustments and the latency of compensatory stepping reactions in humans

A compensatory stepping response is a commonly used strategy in recovering balance control after a postural perturbation. Unlike gait initiation, the compensatory stepping often occurs without an anticipatory postural adjustment (APA), in which body weight is shifted to the swing leg first and then back to the stance leg prior to foot lifting. In postural perturbation studies using a moving platforms stepping responses without an APA were found to have shorter latency to foot lifting than trials with an APA. We studied stepping responses of healthy young adults under postural perturbation of a pulling force impulse on the subjects waist. In contrast to previous studies, the latency of foot lifting was found in the current study to be shorter in the trials with an APA than trials without an APA. Furthermore, greater amplitude of an APA was associated with a shorter latency of foot lifting. Response with an APA of large amplitude may indicate high level of determinant for foot lifting. A pause as to whether or not to initiate/complete a stepping response is suggested to be partially the cause of delayed foot lifting in trials without an APA or with small amplitude of the APA.

Reliability and Validity of Two Tests of Upper Extremity Motor Function Post-Stroke

The Emory Motor Function Test (Wolf, Lecraw, Barton, & Jann, 1989) and the TEMPA (Test Évaluant les Membres superiors des Personnes Âgées) (Desrosiers, Hébert, & Dutil, 1991) are assessments of upper extremity (UE) motor skill. The TEMPA evaluates both speed and quality of movement. The Emory evaluates speed of movement; we modified the Emory by performing quality of movement ratings. The current study tests the inter-rater and test-retest reliability of these instruments in measuring the UE motor skills of individuals post-stroke. Scores on the Emory had inter-rater and test-retest interclass correlation coefficients of greater than .99. The speed of execution and the functional rating scores on the TEMPA also exhibited high inter-rater and test-retest reliabilities, interclass correlation coefficients (ICCs) > .83. While the task analysis ratings for the unilateral TEMPA tasks and the combined ratings were reliable (ICCs > .83), the task analysis ratings for the bilateral TEMPA tasks were less reliable (ICCs ranged from .69 to <.1). Individuals with stroke performed more poorly on both the Emory and the TEMPA than those without stroke. We discuss additional strengths and weaknesses of using each instrument to assess motor skill deficits post-stroke.

Balance and gait of adults with very mild Alzheimer disease.

Background and Purpose:Studies have shown that adults with Alzheimer disease (AD) have gait and balance deficits; however, the focus has been on those with mild to severe disease. The purpose of this study was to determine whether balance and gait deficits are present in those with very mild AD. Methods:Thirteen adults (72.9 ± 4.7 years old) with very mild AD and 13 age-matched (72.6 ± 4.6 years old) and sex-matched (10 males and 3 females) participants in a control group without AD performed balance and gait tests. All participants were living in the community and independent in community ambulation. Results:Participants with very mild AD had shorter times in tandem stance with eyes open (P < 0.001) and with eyes closed (P = 0.007) compared with participants in the control group. Those with AD also took longer to complete the Timed “Up & Go” Test (P < 0.001). Gait deficits were found for those with AD as demonstrated by slower velocities in the 10-m walk at a comfortable pace (P = 0.029) and on an instrumented walkway (P < 0.001). Stance times were longer for those with AD (P < 0.001) and step length was shorter (P = 0.001). There were no group differences in the 10-m walk at a fast pace. The gait velocity of participants in the control group was faster on the instrumented walkway than in the 10-m walk at a comfortable pace (P = 0.031). In contrast, the gait velocity of those with AD was significantly slower on the instrumented walkway than in the 10-m walk at a comfortable pace (P = 0.024). Discussion:Balance and gait deficits may be present in those in the very early stages of AD. Novel surfaces may affect gait speed in those with very mild AD. Identifying mobility deficits early in the progression of AD may provide an opportunity for early physical therapy intervention, thus promoting continued functional independence. Conclusions:Adults in the very early stages of AD may show signs of balance and gait deficits. Recognition of these problems early with subsequent physical therapy may slow the progression of further balance and gait dysfunction.