Effects of early and intensive neuro-rehabilitative treatment on muscle synergies in acute post-stroke patients: a pilot study Randomized clinical trial of therapeutic exercise in subacute stroke. Recovery of standing balance and functional mobility after stroke. A randomized controlled comparison of upper-extremity rehabilitation strategies in acute stroke: A pilot study of immediate and long-term outcomes. Changes in muscle strength, endurance, and reaction of the lower extremities with Tai Chi intervention. Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors Upper-extremity functional electric stimulation-assisted exercises on a workstation in the subacute phase of stroke recovery. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients Effects of Computer-Aided Interlimb Force Coupling Training on Paretic Hand and Arm Motor Control following Chronic Stroke: A Randomized Controlled Trial Concurrent neuromechanical and functional gains following upper-extremity power training post-stroke Impairment–oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study Factors Influencing Stroke Survivors' Quality of Life During Subacute Recovery A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Hand Motor Recovery after Stroke: A Transcranial Magnetic Stimulation Mapping Study of Motor Output Areas and Their Relation to Functional Status
Background After a stroke , patients show significant modifications of neural control of movement , such as abnormal muscle co-activation , and reduced selectivity and modulation of muscle activity . Nonetheless , results reported in literature do not allow to unequivocally explain whether and , in case , how a cerebrovascular accident affects muscle synergies underlying the control of the upper limb . These discrepancies suggest that a complete underst and ing of the modular re-organization of muscle activity due to a stroke is still lacking . This pilot study aim ed at investigating the effects of the conjunction between the natural ongoing of the pathology and the intense robot-mediated treatment on muscle synergies of the paretic upper limb of subacute post-stroke patients . Methods Six subacute patients , homogenous with respect to the age and the time elapsed from the trauma , and ten healthy age-matched subjects were enrolled . The protocol consisted in achieving planar movement of the upper limb while h and ling the end-effector of a robotic platform . Patients underwent 6 weeks long treatment while clinical scores , kinematics of the end-effector and muscle activity were recorded . Then we verified whether muscle coordination underlying the motor task was significantly affected by the cerebrovascular accident and how muscle synergies were modified along the treatment . Results Results show that although muscle synergies in subacute stroke patients were qualitatively comparable to those of healthy subjects , those underlying the movement of the shoulder can reflect the functional deficit induced by the pathology . Moreover , the improvement of motor performance due to the treatment was achieved in conjunction with slight modifications of muscle synergies . In this regard , modifications of muscle synergies appeared to be influenced by the different recovering mechanisms across patients presumably due to the heterogeneity of lesions , sides and location of the accident . Conclusions The results support the hypothesis that muscle synergies reflect the injury of the cerebrovascular accident and could document the effects of the functional recovery due to a suitable and customized treatment . Therefore , they open up new possibilities for the development of more effective neuro-rehabilitation protocol BACKGROUND AND PURPOSE Rehabilitation care after stroke is highly variable and increasingly shorter in duration . The effect of therapeutic exercise on impairments and functional limitations after stroke is not clear . The objective of this study was to determine whether a structured , progressive , physiologically based exercise program for subacute stroke produces gains greater than those attributable to spontaneous recovery and usual care . METHODS This r and omized , controlled , single-blind clinical trial was conducted in a metropolitan area and 17 participating healthcare institutions . We included persons with stroke who were living in the community . One hundred patients ( mean age , 70 years ; mean Orpington score , 3.4 ) consented and were r and omized from a screened sample of 582 . Ninety-two subjects completed the trial . Intervention was a structured , progressive , physiologically based , therapist-supervised , in-home program of thirty-six 90-minute sessions over 12 weeks targeting flexibility , strength , balance , endurance , and upper-extremity function . Main outcome measures were postintervention strength ( ankle and knee isometric peak torque , grip strength ) , upper- and lower-extremity motor control ( Fugl Meyer ) , balance ( Berg and functional reach ) , endurance ( peak aerobic capacity and exercise duration ) , upper-extremity function ( Wolf Motor Function Test ) , and mobility ( timed 10-m walk and 6-minute walk distance ) . RESULTS In the intention-to-treat multivariate analysis of variance testing the overall effect , the intervention produced greater gains than usual care ( Wilk 's lambda=0.64 , P=0.0056 ) . Both intervention and usual care groups improved in strength , balance , upper- and lower-extremity motor control , upper-extremity function , and gait velocity . Gains for the intervention group exceeded those in the usual care group in balance , endurance , peak aerobic capacity , and mobility . Upper-extremity gains exceeded those in the usual care group only in patients with higher baseline function . CONCLUSIONS This structured , progressive program of therapeutic exercise in persons who had completed acute rehabilitation services produced gains in endurance , balance , and mobility beyond those attributable to spontaneous recovery and usual care OBJECTIVE To examine the extent to which recovery of functional balance and mobility is accompanied by change in a few specific physiologic measures of postural control . DESIGN Longitudinal prospect i ve study . SETTING Laboratory setting in Ontario . PARTICIPANTS Twenty-seven volunteers ( age , 64.2+/-13.7y ) undergoing 4 weeks of rehabilitation after stroke participated . At initial testing , patients were 32.7+/-18.4 days poststroke and exhibited a moderate level of motor recovery ( lower-extremity and postural control , stages 3 - 4 on the Chedoke-McMaster Stroke Assessment Impairment Inventory ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three functional measures ( Berg Balance Scale , Clinical Outcome Variables Scale , gait speed ) were assessed . Three physiologic measures ( electromyographic data of hamstrings and soleus muscles bilaterally , postural sway , arm acceleration )  were taken while subjects stood quietly on a force platform and while they performed a rapid shoulder flexion movement of the nonparetic upper extremity . RESULTS After 1 month of rehabilitation , there was an overall significant improvement in all outcome measures ( functional , physiologic ) . However , 10 patients failed to show any improvement in the electromyographic activation of hamstrings muscle on the paretic side in response to the rapid arm movement . These patients compensated by increasing the anticipatory activation of the nonparetic hamstrings . CONCLUSION After stroke , patients showed improvement in both physiologic and functional measures of balance and mobility over a 1-month period . We have identified some patients who may be using compensatory strategies to increase function . The factors that may predict those patients who are likely to use compensatory strategies awaits further study OBJECTIVE To evaluate the immediate and long-term effects of 2 upper-extremity rehabilitation approaches for stroke compared with st and ard care in participants stratified by stroke severity . DESIGN Nonblinded , r and omized controlled trial ( baseline , postintervention , 9mo ) design . SETTING Inpatient rehabilitation hospital and outpatient clinic . PARTICIPANTS Sixty-four patients with recent stroke admitted for inpatient rehabilitation were r and omized within severity strata ( Orpington Prognostic Scale ) into 1 of 3 intervention groups . Forty-four patients completed the 9-month follow-up . INTERVENTIONS St and ard care ( SC ) , functional task practice ( FT ) , and strength training ( ST ) . The FT and ST groups received 20 additional hours of upper-extremity therapy beyond st and ard care distributed over a 4- to 6-week period . MAIN OUTCOME MEASURES Performance measures of impairment ( Fugl-Meyer Assessment ) , strength ( isometric torque ) , and function ( Functional Test of the Hemiparetic Upper Extremity [ FTHUE ] ) . RESULTS Compared with SC participants , those in the FT and ST groups had significantly greater increases in Fugl-Meyer motor scores ( P=.04 ) and isometric torque ( P=.02 ) posttreatment . Treatment benefit was primarily in the less severe participants , where improvement in FT and ST group Fugl-Meyer motor scores more than doubled that of the SC group . Similar results were found for the FTHEU and isometric torque . During the long term , at 9 months , the less severe FT group continued to make gains in isometric muscle torque , significantly exceeding those of the ST group ( P<.05 ) . CONCLUSIONS Task specificity and stroke severity are important factors for rehabilitation of arm use in acute stroke . Twenty hours of upper extremity-specific therapy over 4 to 6 weeks significantly affected functional outcomes . The immediate benefits of a functional task approach were similar to those of a resistance-strength approach , however , the former was more beneficial in the long-term This study examines the effects of a 16-week Tai Chi ( TC ) training program on the muscle strength , endurance , and reaction time of the lower extremities of elderly people . A total of 40 elderly individuals ( aged 60 years ) completed the study . They were divided into two groups : the TC group ( 11 men and 11 women ) underwent a supervised TC exercise program for 16 weeks , while the control group ( 9 men and 9 women ) received general education for a comparable time period . Pre- and post-intervention measurements were conducted . An isokinetic dynamometer was used to measure the maximum concentric strength and dynamic endurance of the knee flexors and the extensors , and the maximum concentric strength of the ankle plantarflexors and dorsiflexors . The neuromuscular response of the rectus femoris , semitendinosus , gastrocnemius , and anterior tibialis muscles was measured by the onset latency to sudden perturbations using an electromyography system . After 16 weeks , the TC group showed a 19.9 % increase in muscle strength of the knee flexors ( p<.000 ) that was significantly greater than that in the control group ( p=.046 ) . There was also a significant decrease in semitendinosus muscle latency ( 6.6 % , p=.014 ) that was significantly shorter than that in the control group ( p=.042 ) . No significant training effects were found in other measures . These results suggest that improving biomechanical characteristics of lower extremity muscles may need longer TC intervention for elderly people Background . Functional electrical stimulation ( FES ) allows active exercises in stroke patients with upper extremity paralysis . Objective . To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and /or h and paralysis . Methods . For this pilot study , 23 acute and subacute stroke patients were r and omly assigned to the intervention ( n = 12 ) and control group ( n = 11 ) . Distributed over 4 weeks , FES training replaced 12 conventional training sessions in the intervention group . An Extended Barthel Index ( EBI ) subscore assessed the performance of activities of daily living ( ADL ) . The Chedoke McMaster Stroke Assessment ( CMSA ) measured h and and arm function and shoulder pain . The Modified Ashworth Scale ( MAS ) assessed resistance to passive movement . Unblinded assessment s were performed prior to and following the end of the training period . Results . The EBI subscore and CMSA arm score improved significantly in both groups . The CMSA h and function improved significantly in the FES group . Resistance to passive movement of finger and wrist flexors increased significantly in the FES group . Shoulder pain did not change significantly . None of the outcome measures , however , demonstrated significant gain differences between the groups . Conclusions . We did not find clear evidence for superiority or inferiority of FES . Our findings , and those of similar trials , suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis OBJECTIVE To test the efficacy of functional electric stimulation (FES)-assisted exercise therapy ( FES-ET ) on a workstation in the subacute phase of recovery from a stroke . DESIGN Single-blind , r and omly controlled comparison of high- and low-intensity treatment . SETTING Laboratory in a rehabilitation hospital . PARTICIPANTS Nineteen stroke survivors ( 10 men , 9 women ; mean age + /- st and ard deviation , 60.6+/-5.8y ) , with upper-extremity hemiplegia ( mean poststroke time , 48+/-17d ) . The main inclusion criteria were : stroke occurred within 3 months of onset of trial and result ed in severe upper-limb dysfunction , and FES produced adequate h and opening . INTERVENTION An FES stimulator and an exercise workstation with instrumented objects were used by 2 groups to perform specific motor tasks with their affected upper extremity . Ten subjects in the high-intensity FES-ET group received FES-ET for 1 hour a day on 15 to 20 consecutive workdays . Nine subjects in the low-intensity FES-ET group received 15 minutes of sensory electric stimulation 4 days a week and on the fifth day they received 1 hour of FES-ET . MAIN OUTCOME MEASURES Primary outcome measure included the Wolf Motor Function Test ( WMFT ) . Secondary outcome measures included the Motor Activity Log ( MAL ) , the upper-extremity portion of the Fugl-Meyer Assessment ( FMA ) , and the combined kinematic score ( CKS ) derived from workstation measurements . The WMFT , MAL , and FMA were used to assess function in the absence of FES whereas CKS was used to evaluate function assisted by FES . RESULTS Improvements in the WMFT and CKS were significantly greater in the high-intensity group ( post-treatment effect size , .95 ) than the low-intensity group ( post-treatment effect size , 1.3 ) . The differences in MAL and FMA were not statistically significant . CONCLUSIONS Subjects performing high-intensity FES-ET showed significantly greater improvements on the WMFT than those performing low-intensity FES-ET . However , this was not reflected in subjects ' self- assessment s ( MAL ) or in their FMA scores , so the clinical significance of the result is open to debate . The CKS data suggest that high-intensity FES-ET may be advantageous in neuroprosthetic applications OBJECTIVE To compare response to upper-limb treatment using robotics plus motor learning ( ML ) versus functional electrical stimulation ( FES ) plus ML versus ML alone , according to a measure of complex functional everyday tasks for chronic , severely impaired stroke survivors . DESIGN Single-blind , r and omized trial . SETTING Medical center . PARTICIPANTS Enrolled subjects ( N=39 ) were > 1 year postsingle stroke ( attrition rate=10 % ; 35 completed the study ) . INTERVENTIONS All groups received treatment 5d/wk for 5h/d ( 60 sessions ) , with unique treatment as follows : ML alone ( n=11 ) ( 5h/d partial- and whole-task practice of complex functional tasks ) , robotics plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of shoulder/elbow robotics ) , and FES plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of FES wrist/h and coordination training ) . MAIN OUTCOME MEASURES Primary measure : Arm Motor Ability Test ( AMAT ) , with 13 complex functional tasks ; secondary measure : upper-limb Fugl-Meyer coordination scale ( FM ) . RESULTS There was no significant difference found in treatment response across groups ( AMAT : P≥.584 ; FM coordination : P≥.590 ) . All 3 treatment groups demonstrated clinical ly and statistically significant improvement in response to treatment ( AMAT and FM coordination : P≤.009 ) . A group treatment paradigm of 1:3 ( therapist/patient ) ratio proved feasible for provision of the intensive treatment . No adverse effects . CONCLUSIONS Severely impaired stroke survivors with persistent ( > 1y ) upper-extremity dysfunction can make clinical ly and statistically significant gains in coordination and functional task performance in response to robotics plus ML , FES plus ML , and ML alone in an intensive and long- duration intervention ; no group differences were found . Additional studies are warranted to determine the effectiveness of these methods in the clinical setting To test the clinical counterpart of the learned nonuse theory , 25 chronic hemiplegic stroke and head-injured patients with minimal to moderate upper extremity extensor muscle function were required to keep their uninvolved upper extremities within a h and -enclosed sling during waking hours over a 2-week interval . During this forced use period and for 1 year thereafter , changes in force or time-based measures among 21 functional tasks were compared to values at the sixth baseline session , a preintervention time when relearning had plateaued . Significant ( P less than 0.05 , Friedman 's repeated measures followed by Tukey multiple comparison tests ) changes were seen in 19 of the 21 tasks with most persisting at the 1-year follow-up . There were no apparent differences between right- and left-sided involvement or between stroke versus head injury clients ( Mann-Whitney procedure ) . Ratings for quality of movement scored from videotapes presented in r and om order showed no change over time . These data suggest that learned nonuse does occur in select neurological patients and that this behavior can be reversed through application of a forced use paradigm Objective We investigated the training effects of interlimb force coupling training on paretic upper extremity outcomes in patients with chronic stroke and analyzed the relationship between motor recovery of the paretic h and , arm and functional performances on paretic upper limb . Design A r and omized controlled trial with outcome assessment at baseline and after 4 weeks of intervention . Setting Taipei Veterans General Hospital , National Yang-Ming University . Participants Thirty-three subjects with chronic stroke were recruited and r and omly assigned to training ( n = 16 ) and control groups ( n = 17 ) . Interventions The computer-aided interlimb force coupling training task with visual feedback included different grip force generation methods on both h and s. Main Outcome Measures The Barthel Index ( BI ) , the upper extremity motor control Fugl-Meyer Assessment ( FMA-UE ) , the Motor Assessment Score ( MAS ) , and the Wolf Motor Function Test ( WMFT ) . All assessment s were executed by a blinded evaluator , and data management and statistical analysis were also conducted by a blinded research er . Results The training group demonstrated greater improvement on the FMA-UE ( p<.001 ) , WMFT ( p<.001 ) , MAS ( p = .004 ) and BI ( p = .037 ) than the control group after 4 weeks of intervention . In addition , a moderate correlation was found between the improvement of scores for h and scales of the FMA and other portions of the FMA UE ( r = .528 , p = .018 ) or MAS ( r = .596 , p = .015 ) in the training group . Conclusion Computer-aided interlimb force coupling training improves the motor recovery of a paretic h and , and facilitates motor control and enhances functional performance in the paretic upper extremity of people with chronic stroke . Trial Registration Clinical Trials.gov NCT02247674 Background Repetitive task practice is argued to drive neural plasticity following stroke . However , current evidence reveals that hemiparetic weakness impairs the capacity to perform , and practice , movements appropriately . Here we investigated how power training ( i.e. , high-intensity , dynamic resistance training ) affects recovery of upper-extremity motor function post-stroke . We hypothesized that power training , as a component of upper-extremity rehabilitation , would promote greater functional gains than functional task practice without deleterious consequences . Method Nineteen chronic hemiparetic individuals were studied using a crossover design . All participants received both functional task practice ( FTP ) and HYBRID ( combined FTP and power training ) in r and om order . Blinded evaluations performed at baseline , following each intervention block and 6-months post-intervention included : Wolf Motor Function Test ( WMFT-FAS , Primary Outcome ) , upper-extremity Fugl-Meyer Motor Assessment , Ashworth Scale , and Functional Independence Measure . Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG . Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining : EMG onset position threshold , burst duration , burst intensity and passive torque at each speed . Results Primary outcome : Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP ( p = .049 ) , regardless of treatment order . These functional improvements were retained 6-months post-intervention ( p = .03 ) . Secondary outcomes : A greater proportion of participants achieved minimally important differences ( MID )  following HYBRID vs. FTP ( p = .03 ) . MIDs were retained 6-months post-intervention . Ashworth scores were unchanged ( p > .05).Increased maximal isometric joint torque , agonist EMG and peak power were significantly greater following HYBRID vs. FTP ( p < .05 ) and effects were retained 6-months post-intervention ( p ’s < .05 ) . EMG position threshold and burst duration were significantly reduced at fast speeds ( ≥120º/s ) ( p ’s < 0.05 ) and passive torque was reduced post-washout ( p < .05 ) following HYBRID . Conclusions Functional and neuromechanical gains were greater following HYBRID vs. FPT . Improved stretch reflex modulation and increased neuromuscular activation indicate potent neural adaptations . Importantly , no deleterious consequences , including exacerbation of spasticity or musculoskeletal complaints , were associated with HYBRID . These results contribute to an evolving body of contemporary evidence regarding the efficacy of high-intensity training in neurorehabilitation and the physiological mechanisms that mediate neural recovery Abstract In a sample of 28 subacute anterior circulation ischemic stroke patients with severe arm paresis , reduced motor cortex excitability ( increased motor thresholds , reduced MEP amplitudes , reduced number of active points ) and a reduced conduction velocity in the corticospinal system were found in the affected hemisphere . At the same time motor cortex topology for the abductor pollicis brevis ( APB ) representation was comparable for the affected and non – affected hemisphere . Considerable arm motor recovery ( Fugl – Meyer test ) was observed when assessed four weeks later after a period of rehabilitation intervention . Motor cortex excitability and conduction velocity in the corticospinal system improved in the affected hemisphere . In addition , APB representation showed a medial shift in patients with such a representation at pre test ( n = 14 ) . Multiple stepwise regression indicated that of all transcranial magnetic stimulation ( TMS ) parameters only the medial shift of the motor cortex map predicted motor recovery . Assessing the effect of training time ( nonintensified vs. intensified therapy ) and type of arm training ( Bobath approach vs. Arm BASIS training ) with a r and omised controlled design revealed that the impairment – oriented Arm BASIS training improved motor control more than the control conditions . In addition , patients of the group receiving the Arm BASIS training with an APB representation at pre test showed a medial shift of the motor cortex map and improved conduction times . In conclusion , changes in motor cortex topology were likely to be relevant for motor recovery and might have been induced by the impairment – oriented training Background and Purpose — Health-related quality of life ( HRQOL ) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery . This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery . Methods — Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial ( Extremity Constraint-Induced Therapy Evaluation ) . HRQOL was assessed using the  Stroke Impact Scale ( SIS ) , Version 3.0 . The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity . Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains . Results — Age , gender , education level , stroke type , concordance ( paretic arm = dominant h and ) , upper extremity motor function ( Wolf Motor Function Test ) , and comorbidities were associated across SIS domains . Poorer HRQOL in the physical domain was associated with age , nonwhite race , more comorbidities , and reduced upper-extremity function . Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking , and those with an ischemic stroke and concordance reported poorer communication . Conclusions — Although results may not generalize to lower functioning stroke survivors , individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive , targeted interventions design ed to maximize recovery and improve HRQOL OBJECTIVE To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation research laboratory and a community hall . PARTICIPANTS A sample of 63 people ( > or = 50y ) with chronic deficits result ing from stroke ( onset > or = 1y ) . INTERVENTIONS The arm group underwent an exercise program design ed to improve upper-extremity function ( 1h/session , 3 sessions/wk for 19wk ) . The leg group underwent a lower-extremity exercise program . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , Fugl-Meyer Assessment ( FMA ) , h and -held dynamometry ( grip strength ) , and the Motor Activity Log . RESULTS Multivariate analysis showed a significant group by time interaction ( Wilks lambda=.726 , P=.017 ) , indicating that overall , the arm group had significantly more improvement than the leg group . Post hoc analysis demonstrated that gains in WMFT ( functional ability ) ( P=.001 ) and FMA ( P=.001 ) scores were significantly higher in the arm group . The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke . Participants with moderate arm impairment benefited more from the program . CONCLUSIONS The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke . This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness OBJECTIVE To examine the benefits of modified constraint-induced movement therapy ( mCIMT ) on motor function , daily function , and health-related quality of life ( HRQOL ) in elderly stroke survivors . DESIGN Two-group r and omized controlled trial , with pretreatment and posttreatment measures . SETTING Rehabilitation clinics . PARTICIPANTS Twenty-six elderly stroke patients ( mean age , 72 y ) with 0.5 to 31 months postonset of a first-ever cerebrovascular accident . INTERVENTIONS Twenty-six patients received either mCIMT ( restraint of the unaffected limb combined with intensive training of the affected limb ) or traditional rehabilitation for a period of 3 weeks . MAIN OUTCOME MEASURES Outcome measures included the Fugl-Meyer Assessment ( FMA ) , FIM instrument , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The FMA evaluated the severity of motor impairment ; the FIM instrument and MAL reported daily function ; and the SIS detected HRQOL . RESULTS The mCIMT group exhibited significantly greater improvements in motor function , daily function , and the physical domain of HRQOL than the traditional rehabilitation group . Patients in the mCIMT group perceived significantly greater percent of recovery after treatment than patients in the traditional rehabilitation group . CONCLUSIONS These findings suggest mCIMT is a promising intervention for improving motor function , daily function , and physical aspects of HRQOL in elderly patients with stroke . The mCIMT was well tolerated by the elderly patients even though it is a rigorous training program The respective contributions of the stroke and undamaged hemispheres to motor recovery after stroke remains controversial . The aim of this article is to evaluate the relationship between location and size of cortical motor areas and outcome after stroke . Twelve controls and 12 stroke patients were studied . H and cortical motor output areas were determined using transcranial magnetic stimulation . Motor-evoked potentials were recorded simultaneously from both h and s. Functional motor abilities were evaluated using well-vali date d measures . Surface area , weighted surface area , and center of gravity of motor output areas were calculated . Different patterns of motor output areas to the paretic h and were observed ; there was no motor output from the stroke hemisphere in patients with poor outcome , contrasting to large motor output area in the stroke hemisphere in patients with good outcome , regardless of infa rct size or location . A significant correlation was found between measures of motor outcome in the stroke-affected upper extremity and both the surface area and weight of the central motor output area in the stroke hemisphere . No ipsilateral motor response was obtained after stimulation of either hemisphere . These data support an association between preservation of cortical motor output area to the paretic h and in the stroke hemisphere and good motor outcome
Conclusions : Age-related differences support the impact of stroke-related sarcopenia as a contributor to hemiparetic muscle dysfunction .
Abstract Background : Despite extensive study of the impact of stroke on muscle and functional performance , questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production .
Objectives : To synthesize available evidence describing post-stroke changes in lower extremity muscle size and strength compared to healthy adults .