scholarly journals Two weeks of ischemic conditioning improves walking speed and reduces neuromuscular fatigability in chronic stroke survivors

2019 ◽  
Vol 126 (3) ◽  
pp. 755-763 ◽  
Author(s):  
Matthew J. Durand ◽  
Timothy F. Boerger ◽  
Jennifer N. Nguyen ◽  
Saad Z. Alqahtani ◽  
Michael T. Wright ◽  
...  
Keyword(s):  
Pilot Study ◽  
Muscle Fatigue ◽  
Sham Group ◽  
Walking Speed ◽  
Knee Extensor ◽  
Cost Effective ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Speed Increase ◽  
Ischemic Conditioning

This pilot study examined whether ischemic conditioning (IC), a noninvasive, cost-effective, and easy-to-administer intervention, could improve gait speed and paretic leg muscle function in stroke survivors. We hypothesized that 2 wk of IC training would increase self-selected walking speed, increase paretic muscle strength, and reduce neuromuscular fatigability in chronic stroke survivors. Twenty-two chronic stroke survivors received either IC or IC Sham on their paretic leg every other day for 2 wk (7 total sessions). IC involved 5-min bouts of ischemia, repeated five times, using a cuff inflated to 225 mmHg on the paretic thigh. For IC Sham, the cuff inflation pressure was 10 mmHg. Self-selected walking speed was assessed using the 10-m walk test, and paretic leg knee extensor strength and fatigability were assessed using a Biodex dynamometer. Self-selected walking speed increased in the IC group (0.86 ± 0.21 m/s pretest vs. 1.04 ± 0.22 m/s posttest, means ± SD; P < 0.001) but not in the IC Sham group (0.92 ± 0.47 m/s pretest vs. 0.96 ± 0.46 m/s posttest; P = 0.25). Paretic leg maximum voluntary contractions were unchanged in both groups (103 ± 57 N·m pre-IC vs. 109 ± 65 N·m post-IC; 103 ± 59 N·m pre-IC Sham vs. 108 ± 67 N·m post-IC Sham; P = 0.81); however, participants in the IC group maintained a submaximal isometric contraction longer than participants in the IC Sham group (278 ± 163 s pre-IC vs. 496 ± 313 s post-IC, P = 0.004; 397 ± 203 s pre-IC Sham vs. 355 ± 195 s post-IC Sham; P = 0.46). The results from this pilot study thus indicate that IC training has the potential to improve walking speed and paretic muscle fatigue resistance poststroke. NEW & NOTEWORTHY This pilot study is the first to demonstrate that ischemic conditioning can improve self-selected walking speed and reduce paretic muscle fatigue in stroke survivors. Ischemic conditioning has been shown to be safe in numerous patient populations, can be accomplished at home or at the bedside in only 45 min, and requires no specialized training. Future larger studies are warranted to determine the efficacy of ischemic conditioning as a neurorehabilitation therapy poststroke.

scholarly journals Two weeks of remote ischemic conditioning improves brachial artery flow mediated dilation in chronic stroke survivors

2020 ◽  
Vol 129 (6) ◽  
pp. 1348-1354
Author(s):  
Allison S. Hyngstrom ◽  
Jennifer N. Nguyen ◽  
Michael T. Wright ◽  
Sergey S. Tarima ◽  
Brian D. Schmit ◽  
...  
Keyword(s):  
Brachial Artery ◽  
Cardiovascular Health ◽  
Recurrent Stroke ◽  
Cost Effective ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Flow Mediated Dilation ◽  
Remote Ischemic Conditioning ◽  
Ischemic Conditioning ◽  
Artery Flow

In this study, we report that 2 wk of remote ischemic conditioning (RIC) improves brachial artery flow-mediated dilation in chronic stroke survivors. Because poor cardiovascular health puts stroke survivors at a heightened risk for recurrent stroke and other cardiovascular events, an intervention that is simple, cost-effective, and easy to perform like RIC holds promise as a means to improve cardiovascular health in this at-risk population.

scholarly journals Ischemic conditioning increases strength and volitional activation of paretic muscle in chronic stroke: a pilot study

2018 ◽  
Vol 124 (5) ◽  
pp. 1140-1147 ◽  
Author(s):  
Allison S. Hyngstrom ◽  
Spencer A. Murphy ◽  
Jennifer Nguyen ◽  
Brian D. Schmit ◽  
Francesco Negro ◽  
...  
Keyword(s):  
Motor Unit ◽  
Muscle Activation ◽  
Knee Extensor ◽  
Chronic Stroke ◽  
Motor Unit Recruitment ◽  
Stroke Survivors ◽  
Single Session ◽  
Ischemic Conditioning ◽  
Leg Strength ◽  
Knee Extensor Strength

Ischemic conditioning (IC) on the arm or leg has emerged as an intervention to improve strength and performance in healthy populations, but the effects on neurological populations are unknown. The purpose of this study was to quantify the effects of a single session of IC on knee extensor strength and muscle activation in chronic stroke survivors. Maximal knee extensor torque measurements and surface EMG were quantified in 10 chronic stroke survivors (>1 yr poststroke) with hemiparesis before and after a single session of IC or sham on the paretic leg. IC consisted of 5 min of compression with a proximal thigh cuff (inflation pressure = 225 mmHg for IC or 25 mmHg for sham) followed by 5 min of rest. This was repeated five times. Maximal knee extensor strength, EMG magnitude, and motor unit firing behavior were measured before and immediately after IC or sham. IC increased paretic leg strength by 10.6 ± 8.5 Nm, whereas no difference was observed in the sham group (change in sham = 1.3 ± 2.9 Nm, P = 0.001 IC vs. sham). IC-induced increases in strength were accompanied by a 31 ± 15% increase in the magnitude of muscle EMG during maximal contractions and a 5% decrease in motor unit recruitment thresholds during submaximal contractions. Individuals who had the most asymmetry in strength between their paretic and nonparetic legs had the largest increases in strength ( r2 = 0.54). This study provides evidence that a single session of IC can increase strength through improved muscle activation in chronic stroke survivors. NEW & NOTEWORTHY Present rehabilitation strategies for chronic stroke survivors do not optimally activate paretic muscle, and this limits potential strength gains. Ischemic conditioning of a limb has emerged as an effective strategy to improve muscle performance in healthy individuals but has never been tested in neurological populations. In this study, we show that ischemic conditioning on the paretic leg of chronic stroke survivors can increase leg strength and muscle activation while reducing motor unit recruitment thresholds.

scholarly journals Investigating the feasibility and acceptability of real-time visual feedback in reducing compensatory motions during self-administered stroke rehabilitation exercises: A pilot study with chronic stroke survivors

2019 ◽  
Vol 6 ◽  
pp. 205566831983163 ◽  
Author(s):  
Shayne Lin ◽  
Jotvarinder Mann ◽  
Avril Mansfield ◽  
Rosalie H Wang ◽  
Jocelyn E Harris ◽  
...  
Keyword(s):  
Pilot Study ◽  
Upper Extremity ◽  
Visual Feedback ◽  
Feedback System ◽  
Optimal Recovery ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Perfect Agreement ◽  
Rehabilitation Programs ◽  
Shoulder Elevation

Introduction Homework-based rehabilitation programs can help stroke survivors restore upper extremity function. However, compensatory motions can develop without therapist supervision, leading to sub-optimal recovery. We developed a visual feedback system using a live video feed or an avatar reflecting users' movements so users are aware of compensations. This pilot study aimed to evaluate validity (how well the avatar characterizes different types of compensations) and acceptability of the system. Methods Ten participants with chronic stroke performed upper-extremity exercises under three feedback conditions: none, video, and avatar. Validity was evaluated by comparing agreement on compensations annotated using video and avatar images. A usability survey was administered to participants after the experiment to obtain information on acceptability. Results There was substantial agreement between video and avatar images for shoulder elevation and hip extension (Cohen's κ: 0.6–0.8) and almost perfect agreement for trunk rotation and flexion (κ: 0.80–1). Acceptability was low due to lack of corrective prompts and occasional noise with the avatar display. Most participants suggested that an automatic compensation detection feature with visual and auditory cuing would improve the system. Conclusion The avatar characterized four types of compensations well. Future work will involve increasing sensitivity for shoulder elevation and implementing a method to detect compensations.

O-08 Brain connectivity modulation after exoskeleton gait in chronic stroke survivors: a pilot study

2019 ◽  
Vol 130 (7) ◽  
pp. e23
Author(s):  
Alessandra Del Felice ◽  
Emanuela Formaggio ◽  
Eleonora Guanziroli ◽  
Anna Bosco ◽  
Francesco Piccione ◽  
...  
Keyword(s):  
Pilot Study ◽  
Brain Connectivity ◽  
Chronic Stroke ◽  
Stroke Survivors

scholarly journals Dynamic Stability and Trunk Control Improvements Following Robotic Balance and Core Stability Training in Chronic Stroke Survivors: A Pilot Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Alice De Luca ◽  
Valentina Squeri ◽  
Laura M. Barone ◽  
Honorè Vernetti Mansin ◽  
Serena Ricci ◽  
...  
Keyword(s):  
Pilot Study ◽  
Dynamic Stability ◽  
Chronic Stroke ◽  
Core Stability ◽  
Stroke Survivors ◽  
Trunk Control ◽  
Stability Training

scholarly journals Effects of Robot Viscous Forces on Arm Movements in Chronic Stroke Survivors: A Randomized Crossover Study

2020 ◽  
Author(s):  
Yazan Abdel Majeed ◽  
Saria Awadalla ◽  
James Patton
Keyword(s):  
Test Methods ◽  
Chronic Stroke ◽  
Movement Speed ◽  
Institutional Review Boards ◽  
Stroke Survivors ◽  
Practice Trial ◽  
Speed Increase ◽  
Viscous Forces ◽  
Institutional Review ◽  
Negative Viscosity

Abstract Background Our previous work showed that speed is linked to the ability to recover in chronic stroke survivors. Patients moving faster on the first day of a three-week study had greater improvements on the Wolf Motor Function Test. Methods We examined the effects of three candidate speed-modifying fields in a crossover design: negative viscosity, positive viscosity, and a "breakthrough" force that vanishes after speed exceeds an individualized threshold. Results Negative viscosity resulted in a significant speed increase when it was on. No lasting after effects on movement speed were observed from any of these treatments, however, training with negative viscosity led to significant improvements in movement accuracy and smoothness. Conclusions Our results suggest that negative viscosity could be used as a treatment to augment the training process while still allowing patients to make their own volitional motions in practice. Trial registration This study was approved by the Institutional Review Boards at Northwestern University (STU00206579) and the University of Illinois at Chicago (2018-1251).

scholarly journals Effects of Robot Viscous Forces on Arm Movements in Chronic Stroke Survivors: A Randomized Crossover Study

2020 ◽  
Author(s):  
Yazan Abdel Majeed ◽  
Saria Awadalla ◽  
James Patton
Keyword(s):  
Chronic Stroke ◽  
Movement Speed ◽  
Institutional Review Boards ◽  
Stroke Survivors ◽  
Speed Increase ◽  
After Effects ◽  
Viscous Forces ◽  
Institutional Review ◽  
Wolf Motor Function Test ◽  
Negative Viscosity

Abstract Background: Our previous work showed that speed is linked to the ability to recover in chronic stroke survivors. Participants moving faster on the first day of a three-week study had greater improvements on the Wolf Motor Function Test.Methods: We examined the effects of three candidate speed-modifying fields in a crossover design: negative viscosity, positive viscosity, and a "breakthrough" force that vanishes after speed exceeds an individualized threshold.Results: Negative viscosity resulted in a significant speed increase when it was on. No lasting after effects on movement speed were observed from any of these treatments, however, training with negative viscosity led to significant improvements in movement accuracy and smoothness.Conclusions: Our results suggest that negative viscosity could be used as a treatment to augment the training process while still allowing participants to make their own volitional motions in practice.Trial registration: This study was approved by the Institutional Review Boards at Northwestern University (STU00206579) and the University of Illinois at Chicago (2018-1251).

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