scholarly journals Measurement of passive ankle stiffness in subjects with chronic hemiparesis using a novel ankle robot

2011 ◽  
Vol 105 (5) ◽  
pp. 2132-2149 ◽  
Author(s):  
Anindo Roy ◽  
Hermano I. Krebs ◽  
Christopher T. Bever ◽  
Larry W. Forrester ◽  
Richard F. Macko ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Frontal Plane ◽  
Chronic Stroke ◽  
Healthy Adults ◽  
Stroke Survivors ◽  
Passive Stiffness ◽  
Mechanical Stiffness ◽  
Treatment Protocols ◽  
Ankle Stiffness ◽  
Hemiparetic Stroke

Our objective in this study was to assess passive mechanical stiffness in the ankle of chronic hemiparetic stroke survivors and to compare it with those of healthy young and older (age-matched) individuals. Given the importance of the ankle during locomotion, an accurate estimate of passive ankle stiffness would be valuable for locomotor rehabilitation, potentially providing a measure of recovery and a quantitative basis to design treatment protocols. Using a novel ankle robot, we characterized passive ankle stiffness both in sagittal and in frontal planes by applying perturbations to the ankle joint over the entire range of motion with subjects in a relaxed state. We found that passive stiffness of the affected ankle joint was significantly higher in chronic stroke survivors than in healthy adults of a similar cohort, both in the sagittal as well as frontal plane of movement, in three out of four directions tested with indistinguishable stiffness values in plantarflexion direction. Our findings are comparable to the literature, thus indicating its plausibility, and, to our knowledge, report for the first time passive stiffness in the frontal plane for persons with chronic stroke and older healthy adults.

Abstract TP146: Impaired Glucose Metabolism is Associated With Metabolic Inflexibility During Submaximal Exercise in Chronic Stroke Survivors

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Monica C Serra ◽  
Charlene E Hafer-Macko ◽  
Frederick M Ivey ◽  
Alice S Ryan
Keyword(s):  
Glucose Tolerance ◽  
Stress Test ◽  
Submaximal Exercise ◽  
Chronic Stroke ◽  
Carbohydrate Oxidation ◽  
Exercise Stress ◽  
Oral Glucose ◽  
Stroke Survivors ◽  
Metabolic Inflexibility ◽  
Hemiparetic Stroke

We have previously shown that 27% and 45% of chronic stroke survivors have impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), respectively, placing them at high risk for the development of type 2 diabetes (T2DM). These glucose abnormalities may contribute to metabolic inflexibility, which is the failure to appropriately adapt substrate oxidation to substrate availability. Thus, we tested the hypothesis that the ability to shift from fat (respiratory exchange ratio (RER)=0.7) to carbohydrate (RER=1.0) oxidation during exercise is reduced in stroke survivors with increasing fasting (G0) and 2-hr oral glucose tolerance test (G120) glucose levels. Chronic hemiparetic stroke patients without T2DM (N=18; 63±2 year old; mean±SEM) underwent a graded exercise stress test, with indirect calorimetry for measurement of peak fitness (VO 2 peak). Additionally, we measured RER at rest and during submaximal exercise (60% of VO 2 peak), and subjects completed an OGTT for measurement of G0 and G120. On average, subjects were obese (BMI: 30±2 kg/m 2 ; 19-45 ml/kg/min) and had poor VO 2 peak levels (20±1 ml/kg/min; 9-33 ml/kg/min). Thirty three percent had neither IFG nor IGT, while 33% had IFG (G0: 5.22±0.19 mmol/L), 56% had IGT (G120: 7.94±0.49 mmol/L), and 22% had both IFG and IGT. At rest, RER was 0.71±0.01 and increased to 0.78±0.01 at 60% of VO 2 peak (P<0.01). After controlling for obesity and VO 2 peak, G0 related to RER at 60% of VO 2 peak (r=-0.47) and the change in RER (60%VO 2 peak-rest; r=-0.42) (P’s<0.05). G120 also related to the change in RER (r=-0.36) (P’s<0.05). Our results indicate that lower carbohydrate oxidation and the change in carbohydrate oxidation during exercise of increasing intensity are related to hyperglycemia in chronic stroke survivors. This inflexibility may limit the capacity to fulfill the energy requirements of daily physical activity performance, thereby heightening the probability of a more sedentary lifestyle post-stroke.

scholarly journals Stroke Sarcopenia Patients Cause Weakness and Atrophy in the Knee and Ankle Joints

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 214-214
Author(s):  
Yamanoi Jyunya
Keyword(s):  
Knee Joint ◽  
Ankle Joint ◽  
Muscle Weakness ◽  
Muscle Atrophy ◽  
Lower Limb ◽  
Chronic Stroke ◽  
Triceps Surae ◽  
Stroke Survivors ◽  
Lower Limb Muscle ◽  
Limb Muscle

Abstract Objectives Chronic stroke survivors tend to be inactive, often with sarcopenia, and have decreased physical function and activities of daily living. Muscle atrophy and weakness differ between sarcopenia patients and stroke patients. Therefore, it is difficult to evaluate physiotherapy and intervention for sarcopenic patients with stroke. The purpose of this study was to identify muscles that cause muscle weakness and muscle atrophy in stroke sarcopenia patients. Methods The subjects were 117 chronic stroke survivors who were 65 years or older. Subjects were determined using the criteria of the Asian Working Group on Sarcopenia in 2019 to determine the presence of sarcopenia and were classified into sarcopenia group (SG, n = 60) and non sarcopenia group (nSG, n = 57). Atrophy assessments obtained unaffected lower limb muscle thickness (iliopsoas, gluteus maximus, gluteus medius, hamstrings, quadriceps femoris, tibialis anterior, triceps surae) using B-mode of transverse ultrasound imaging. Strength assessments obtained unaffected lower limb muscle strength (flexion, extension, abduction, adduction, external rotation and internal rotation of hip joint, flexion and extension of knee joint, planter flexion and dorsiflexion of ankle joint) using handheld dynamometer. We conducted a Student's t-test to compare the two groups. A P-value of &lt;0.05 was considered to show statistical significance for all analyses. When the significance level is less than 0.05, the power is also calculated, and it is considered that the significant difference can be secured when P &lt; 0.05 and power &gt;0.8. We conducted with the approval of the ethics committee of Aichi Saiseikai Rehabilitation Hospital (201,908). Results SG had muscle atrophy in all muscles compared to nSG (P &lt; 0.05, power &gt;0.8). SG had muscle weakness in all joint direction compared to nSG (P &lt; 0.05, power &gt;0.8). In particular, extension of knee joint and planter flexion of ankle joint muscle weakness, quadriceps femoris and triceps surae muscle atrophy occurred (P &lt; 0.01, power &gt;0.8). Conclusions Assessment and intervention of skeletal muscle in stroke sarcopenia patients should focus on the knee joint and ankle joint. Funding Sources The authors declare no conflicts of interest associated with this manuscript.

The Effects of Ankle Joint Mobilization on Dorsiflexion Range and Gait Parameters in Chronic Stroke Survivors: A Systematic Review and Meta-analysis

2021 ◽  
pp. 251660852098287
Author(s):  
Hariharasudhan Ravichandran ◽  
Balamurugan Janakiraman
Keyword(s):  
Ankle Joint ◽  
Meta Analysis ◽  
Step Length ◽  
Chronic Stroke ◽  
Gait Velocity ◽  
Stroke Survivors ◽  
Timed Up And Go ◽  
Unaffected Side ◽  
Joint Mobilization ◽  
Gait Parameters

Background: Ankle dorsiflexion movement restriction is a common presentation in most of the chronic stroke survivors. Spasticity and connective tissue changes around ankle, limits dorsiflexion, and interferes with balance and gait performances. Improving functional range of dorsiflexion is essential in post-stroke rehabilitation. Objectives: This meta-analysis analyzed the effects of ankle mobilization techniques in improving dorsiflexion range and gait parameters among chronic stroke survivors. Method: Articles published up to July 2020 were searched in CINAHL, PubMed, Embase, PsyINFO, and OpenGrey. English version of randomized controlled trials (RCTs) assessing the effects of ankle joint mobilization among chronic stroke subjects, with dorsiflexion range of motion (ROM) and gait parameters as outcome, were included. Characteristics of participants, interventions, outcome measure, and measures of variability were extracted. Methodological quality of included trials was assessed using PEDro scale and Cochrane Collaboration tool for the risk of bias. Pooled standardized mean difference was calculated using random effects model for dorsiflexion ROM, gait velocity, step length, cadence, and timed up and go (TUG). Results: Eight RCTs including 226 stroke patients, with mean methodological score of 6 out of 10 in PEDro, were eligible for this meta-analysis. Ankle joint mobilization demonstrated statistically significant improvement on passive dorsiflexion ROM, gait velocity, step length (affected side), and cadence outcomes. Nonsignificance was found in step length (unaffected side) and in TUG. Conclusion: The ankle mobilization techniques are effective in improving passive dorsiflexion ROM, gait velocity, and cadence in chronic stroke survivors. However, the retention effect of ankle mobilization among stroke subjects is not known.

Achilles tendon morphology, plantar flexors torque and passive ankle stiffness in spastic hemiparetic stroke survivors

2017 ◽  
Vol 41 ◽  
pp. 72-76 ◽  
Author(s):  
Bruno Freire ◽  
Caroline Pieta Dias ◽  
Natália Batista Albuquerque Goulart ◽  
Camila Dias de Castro ◽  
Jefferson Becker ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Stroke Survivors ◽  
Plantar Flexors ◽  
Ankle Stiffness ◽  
Hemiparetic Stroke

scholarly journals Effects of Robot-Aided Rehabilitation on the Ankle Joint Properties and Balance Function in Stroke Survivors: A Randomized Controlled Trial

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiaoxue Zhai ◽  
Qiong Wu ◽  
Xin Li ◽  
Quan Xu ◽  
Yanlin Zhang ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Outcome Measures ◽  
Controlled Trial ◽  
Control Group ◽  
Stroke Survivors ◽  
Balance Function ◽  
Post Stroke ◽  
Ankle Stiffness ◽  
Eyes Open ◽  
Experimental Group

Background: Stroke survivors with impaired control of the ankle due to stiff plantarflexors often experience abnormal posture control, which affects balance and locomotion. Forceful stretching may decrease ankle stiffness and improve balance. Recently, a robot-aided stretching device was developed to decrease ankle stiffness of patient post-stroke, however, their benefits compared to manual stretching exercises have not been done in a randomized controlled trial, and the correlations between the ankle joint biomechanical properties and balance are unclear.Objective: To compare the effects of robot-aided to manual ankle stretching training in stroke survivors with the spastic ankle on the ankle joint properties and balance function post-stroke, and further explore the correlations between the ankle stiffness and balance.Methods: Twenty inpatients post-stroke with ankle spasticity received 20 minutes of stretching training daily over two weeks. The experimental group used a robot-aided stretching device, and the control group received manual stretching. Outcome measures were evaluated before and after training. The primary outcome measure was ankle stiffness. The secondary outcome measures were passive dorsiflexion ranges of motion, dorsiflexor muscle strength, Modified Ashworth Scale (MAS), Fugl-Meyer Motor Assessment of Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and the Pro-Kin balance test.Results: After training, two groups showed significantly within-group improvements in dorsiflexor muscle strength, FMA-LE, BBS, MBI (P &lt; 0.05). The between-group comparison showed no significant differences in all outcome measures (P &gt; 0.0025). The experimental group significantly improved in the stiffness and passive range of motion of dorsiflexion, MAS. In the Pro-Kin test, the experimental group improved significantly with eyes closed and open (P &lt; 0.05), but significant improvements were found in the control group only with eyes open (P &lt; 0.05). Dorsiflexion stiffness was positively correlated with the Pro-Kin test results with eyes open and the MAS (P &lt; 0.05).Conclusions: The robot-aided and manual ankle stretching training provided similar significant improvements in the ankle properties and balance post-stroke. However, only the robot-aided stretching training improved spasticity and stiffness of dorsiflexion significantly. Ankle dorsiflexion stiffness was correlated with balance function.Clinical Trial Registration:www.chictr.org.cn ChiCTR2000030108.

Aerobic locomotor exercise modulates brain activation patterns in chronic stroke survivors

2005 ◽  
Vol 32 (S 4) ◽  
Author(s):  
A.R Luft ◽  
L Forrester ◽  
F Villagra ◽  
R Macko ◽  
D.F Hanley
Keyword(s):  
Brain Activation ◽  
Chronic Stroke ◽  
Stroke Survivors ◽  
Activation Patterns

scholarly journals Alterations in Muscle Networks in the Upper Extremity of Chronic Stroke Survivors

2021 ◽  
pp. 1-1
Author(s):  
Michael Houston ◽  
Xiaoyan Li ◽  
Ping Zhou ◽  
Sheng Lia ◽  
Jinsook Roh ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Chronic Stroke ◽  
Stroke Survivors
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