Comparing Neuroplasticity Changes Between High and Low Frequency Gait Training in Subacute Stroke: Protocol for a Randomized, Single-Blinded, Controlled Study.

AimsLiuzijue Qigong (LQG) exercise is a traditional Chinese exercise method in which breathing and pronunciation are combined with movement guidance. Breathing is closely related to balance, and LQG, as a special breathing exercise, can be applied to balance dysfunction after stroke. The purpose of this study was to observe the clinical effects of short-term LQG exercise on balance function in patients recovering from stroke.MethodsStroke patients were randomly divided into an Intervention Group (IG) (n = 80) and a Control Group (CG) (n = 80). The IG received conventional rehabilitation training plus LQG and the CG received conventional rehabilitation training plus Core Stability Training (CST). All patients received treatment once a day, 5 times a week for 2 weeks. The primary outcome was Berg Balance Scale (BBS). Secondary outcome measures were static standing and sitting balance with eyes open and closed, Fugl-Meyer Assessment (FMA), Maximum Phonation Time (MPT), Modified Barthel Index (MBI) and diaphragm thickness and mobility during quiet breath (QB) and deep breath (DB).ResultsCompared with the CG, the IG showed significant improvement in the BBS (10.55 ± 3.78 vs. 9.06 ± 4.50, P = 0.039), MPT (5.41 ± 4.70 vs. 5.89 ± 5.24, P = 0.001), MBI (12.88 ± 6.45 vs. 10.00 ± 4.84, P = 0.003), diaphragmatic mobility during QB (0.54 ± 0.73 vs. 0.33 ± 0.40, P = 0.01) and diaphragmatic mobility during DB (0.99 ± 1.32 vs. 0.52 ± 0.77, P = 0.003), Cop trajectory in the standing position with eyes open (−108.34 ± 108.60 vs. −89.00 ± 140.11, P = 0.034) and Cop area in the standing positions with eyes open (−143.79 ± 431.55 vs. −93.29 ± 223.15, P = 0.015), Cop trajectory in the seating position with eyes open (−19.95 ± 23.35 vs. −12.83 ± 26.64, P = 0.001) and Cop area in the seating position with eyes open (−15.83 ± 9.61 vs. −11.29 ± 9.17, P = 0.002).ConclusionsThe short-term LQG combined with conventional rehabilitation training significantly improved the balance functions of stroke patients. It also improved static standing and sitting balance with the eyes open, diaphragm functions, maximum phonation time and the quality of daily life for stroke patients.Clinical Trial Registrationhttp://www.chictr.org.cn/edit.aspx?pid=25313&htm=4, Identifier: ChiCTR1800014864.

Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke.

Comparative Effect of Liuzijue Qigong and Conventional Respiratory Training on Trunk Control Ability and Respiratory Muscle Function in Patients at an Early Recovery Stage From Stroke: A Randomized Controlled Trial

Objective To study the effect of core stability training on motor function in patients with hemiplegia after stroke. Methods Sixty-eight patients with hemiplegia after stroke were randomly divided into a treatment group (34 cases) and a control group (34 cases).Both groups were given regular rehabilitation training.The patients in the treatment group also were taught core stability training.The trunk control test (TCT),Berg's balance scale (BBS),the modified Barthel index (MBI),functional ambulation categories (FACs) and the Fugl-Meyer assessment scale (FMA) were used to assess motor function before and after treatment. Results There were significant differences between the two groups in average TCT scores,BBS scores,FACs,M BI scores and FMA scores after treatment.The gains in the treatment group were significantly superior to those in the control group.The patients'trunk control was positively correlated with the BBS,MBI,FAC and FMA results. Conclusion Core stability training can improve the motor function of patients with hemiplegia after stroke. Key words: Core stability training; Stroke; Hemiplegia; Balance; Walking; Activities of daily living; Motor function

Wearable powered exoskeletons provide intensive overground gait training with patient's active participation: these features promote a successful active motor relearning of ambulation in stroke survivors. The aim of this study was to investigate the feasibility and the clinical effects of an overground exoskeleton-assisted gait training (OEAGT) in subacute stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. Four Italian neurological rehabilitation centers. Forty-eight subacute stroke patients were enrolled. Two patients dropped out because of medical problems. Data analysis was conducted on 46 subjects (56.84±14.29 years; 27 male; 29 ischemic; 24 left hemiparesis). Patients underwent 15±2 sessions (60 min/session, 3-5 times/week) of OEAGT. Clinical and gait assessments were performed at the beginning (T1) and at the end (T2) of the training period: modified Barthel Index (BI), modified Ashworth Scale at Hip (MAS-H), Knee (MAS-K), and Ankle (MAS-A) level, Motricity Index (MI), Trunk Control Test (TCT), Functional Ambulation Classification (FAC), Walking Handicap Scale (WHS), 10-Meter Walking Test (10MWT), 6-Minute Walking Test (6mWT), Timed Up-and-Go test (TUG). The Technology Acceptance Model (TAM) questionnaire evaluated the acceptance of OEAGT by patients. Data stratification was performed using the time post the acute event and the onset of rehabilitation treatment, and the MI at T1. Wilcoxon's test (P<0.05) was used. All clinical scales significantly improved at T2; no statistically significant changes were reported for MAS-H, MAS-K, MAS-A. The 69.57% patients were able to walk at T1; 17.39% were not able to walk at T1 but regained ambulation at T2; and 13.04% were not able to walk at either T1 or T2. The ambulant patients showed a statistical improvement in speed measured during the 10MWT and in the distance covered over a time of 6 minutes (6mWT). The results from the TAM questionnaire showed that all subjects perceived the OEAGT positively. The data stratification analysis suggests that the OEAGT does not have any restriction of use. The OEAGT improved the clinical and gait outcomes in subacute patients. Randomized studies on larger samples are needed to confirm these data and to assess the efficacy of OEAGT. Introduce innovative rehabilitation strategies based on customized OEAGT.

Diabetic neuropathy (DN) in the elderly is a common complication of diabetes that can negatively influence balance control. In this study, we aimed to evaluate the efficacy of balance training program on postural stability of diabetic patients. In this randomized clinical trial, 34 elderly DN patients were divided into intervention (n = 17) and control (n = 17) groups. The experimental group underwent a balance training program using the Biodex Balance System (BBS) for 10 sessions. All subjects in both groups were assessed using timed 'up and go' (TUG) test, the Berg balance scale, and the fall risk and postural stability tests, at baseline and at the end of the study. TUG (p = 0.01), fall risk index (p = 0.002), anterior/posterior index (p = 0.01), medial/lateral index (p = 0.04), overall stability index (p = 0.01) and Berg balance scale (p = 0.04) were significantly improved after the training in the intervention group, but had no significant differences in the control group. The changes in TUG (p < 0.001) and fall risk index (p < 0.001) in the intervention group were significantly higher than those in the control group. According to our results, balance training would improve postural stability and balance in elderly patients with DN.

Simple SummaryStroke patients commonly have different lower extremity biomechanical abnormalities that severely affect walking after damage to normal neural pathways, however, little attention has been paid to them, and current gait rehabilitation techniques have made limited efforts to provide patients with consistent, stable, and effective correction when walking. In the present study, we investigated whether customized insoles could improve gait performance in hemiplegic stroke patients, and the results showed that customized insoles could be a valid intervention that targets residual hemiplegic gait after stroke, thereby enhancing walking function and improving the quality of life of the patients.Background: Insoles have been widely applied to many diseases, but stroke involves complex problems and there is a paucity of research on the application of insoles in stroke patients. Aim: To evaluate the effect of customized insoles on gait in patients with hemiplegia. Design: A randomized controlled trial. Setting: Rehabilitation department of a hospital. Population: A total of 50 stroke patients were randomized into an experimental group (n = 25) or a control group (n = 25). Methods: Both groups received conventional gait training, which was conducted five times a week, every 40 min for four weeks and patients in the experimental group were required to wear customized insoles for at least 1 h per day for four weeks. The primary outcome measure was the Tinetti Gait Scale (TGS) and the secondary outcome measures were the plantar pressure test, 6-min walking test (6MWT), lower extremity Fugl–Meyer assessment (FMA-LE), Berg Balance Scale (BBS), and the modified Barthel index (MBI). Results: Compared to the control group, there were significant increases in the experimental group after four weeks (p = 0.014) and at the four week follow-up (p = 0.001) in the change in TGS, weight-bearing on the involved side (p = 0.012) or forefoot (p = 0.028) when standing, weight-bearing on the involved side (p = 0.01 6) or forefoot (p = 0.043) when walking, early stance phase (p = 0.023) and mid stance phase (p = 0.013) on the involved side, FMA-LE (p = 0.029), BBS (p = 0.005), and MBI (p = 0.009), but there were no differences in the late stance phase (p = 0.472) on the involved side when walking or in the 6MWT (p = 0.069). Conclusions: Customized insoles had great efficacy in enhancing gait performance in stroke patients.

Balance dysfunction is common after stroke, yet subacute patients often are often unable to perform traditional Baduanjin exercises due to severe motor impairments. The objective of this study was to determine whether a modified Baduanjin program, adapted to sitting and standing positions, could improve balance function in subacute stroke survivors beyond conventional rehabilitation. Fifty-four subacute stroke patients were randomly assigned to receive either conventional rehabilitation plus modified Baduanjin (40 min daily, n = 27) or conventional rehabilitation alone (80 min daily, n = 27), five days per week for six weeks. The primary outcome was performance on the Berg Balance Scale (BBS); secondary outcomes included lower extremity motor function (FMA-LE), functional independence (MBI), and dynamic balance during walking assessed by 3D motion analysis. Patients in the modified Baduanjin group demonstrated significantly greater improvements in balance (BBS: between-group difference 6.1 points, 95% CI: 2.5–9.7, p = 0.001), lower extremity motor function (FMA-LE: 2.3 points, p = 0.019), and functional independence (MBI: 8.4 points, p < 0.001) compared to controls. Dynamic balance during walking, as measured by mediolateral sway amplitude, also showed greater improvement in the intervention group (p = 0.015). The intervention was associated with high adherence (94%) and was well tolerated, with no serious adverse events reported. Modified Baduanjin is expected to become a safe and viable adjunctive intervention that could help patients with subacute stroke improve their balance in addition to conventional rehabilitation. These preliminary findings warrant confirmation by multicenter trials on a larger scale.

Although the Mini-Balance Evaluation Systems Test (Mini-BESTest) is known to be a reliable and valid measure of balance in individuals with stroke, the utility of this tool in relation to subacute stroke walking speed and the recovery of gait ability has not been explored. Here, we compared the measurement properties and their relationship to gait speed on the Mini-BESTest and the Berg Balance Scale (BBS) in middle and older ambulatory individuals with subacute stroke, and we investigated which balance assessment tool is more likely to capture the status of the recovery of gait speed. We retrospectively analyzed the cases of 88 individuals 50 years or older with stroke who had been evaluated using the Mini-BESTest by using the BBS and by assessing their comfortable walking speed (CWS). The proportion of subjects who showed improvement was calculated for 34 stroke survivors from data obtained at admission to and discharge from the hospital. Compared with the BBS, the Mini-BESTest showed a better distribution of total scores without a ceiling effect. The two scales showed correlations with gait speed (Mini-BESTest: r=0.702; BBS: r=0.592) and discrimination between fast and slow walkers. The responsiveness of the Mini-BESTest was excellent, with an area under the curve of 0.894, thus discriminating between gait speed improvement versus non-improvement. These results indicate that the Mini-BESTest is more useful than the BBS in terms of its measurement properties and ability to measure gait recovery in middle and older ambulatory individuals with subacute stroke.

Baduanjin exercise ameliorates motor function in patients with post-stroke cognitive impairment: A randomized controlled trial

Background. Balance dysfunction and high dual-task costs are eminent features in multiple sclerosis (MS). Vestibular rehabilitation therapy (VRT) proved to promote functional outcomes; yet, its influence on dynamic balance and dual-task cost of walking (DTCW) in MS needs further research. Objective. To investigate the effect of adding VRT to aerobic training on dynamic balance and DTCW in people with MS. Design. Single blinded, parallel randomized controlled trial. Settings. Out-Patient Clinic at Faculty of Physical Therapy and Kasr Al-Ainy Multiple Sclerosis Unit, Cairo University, Egypt. Participants. 40 patients with remitting-relapsing multiple sclerosis. Intervention. Patients were randomized to a control (n = 20) and intervention (n = 20) groups. Over four successive weeks, all patients received stationary bicycle aerobic training. Intervention group received an additional VRT program. Outcomes measures. Berg Balance Scale (BBS), walking speed tested by the 10 meters timed walk test (10 m-TWT), (DTCW), and overall stability index (SI). Results. Intervention group showed a remarkable improvement in BBS (p = 0.02), SI at levels four (p = 0.002) and seven (p = 0.03), and DTCW (p = 0.03) compared with control group. Walking speed did not show significant changes post-treatment within or between groups comparison (P &gt; 0.05). Conclusion. Adding VRT to aerobic training has a positive effect on dynamic balance and dual-task cost of walking in MS.

Background: Evidence-based complementary treatment options for multiple sclerosis (MS) are limited. Objective: To investigate the effect of hippotherapy plus standard care versus standard care alone in MS patients. Methods: A total of 70 adults with MS were recruited in five German centers and randomly allocated to the intervention group (12 weeks of hippotherapy) or the control group. Primary outcome was the change in the Berg Balance Scale (BBS) after 12 weeks, and further outcome measures included fatigue, pain, quality of life, and spasticity. Results: Covariance analysis of the primary endpoint resulted in a mean difference in BBS change of 2.33 (95% confidence interval (CI): 0.03–4.63, p = 0.047) between intervention (n = 32) and control (n = 38) groups. Benefit on BBS was largest for the subgroup with an Expanded Disability Status Scale (EDSS) ⩾ 5 (5.1, p = 0.001). Fatigue (−6.8, p = 0.02) and spasticity (−0.9, p = 0.03) improved in the intervention group. The mean difference in change between groups was 12.0 (p < 0.001) in physical health score and 14.4 (p < 0.001) in mental health score of Multiple Sclerosis Quality of Life-54 (MSQoL-54). Conclusion: Hippotherapy plus standard care, while below the threshold of a minimal clinically important difference, significantly improved balance and also fatigue, spasticity, and quality of life in MS patients.

Objective: Setting therapeutic goals assist to identify patient priorities and predict problem that may arise in performing daily and functional activities. Goal setting is associated with improved rehabilitation outcomes in individuals with hemiparetic stroke. This study was conducted to assess the effects of having awareness and satisfaction of goals on the functional status of individuals with hemiparetic stroke. Design: Cross-sectional study. Methods: Eighty-one people who had been diagnosed with stroke participated in this study. The study was conducted through a face-to-face surveys to identify participants’ awareness and satisfaction of goals and standard assessment tools were used to evaluate patients’ functional status. This study measured functional status through three clinical measures including the manual function test (MFT), Berg Balance scale (BBS), and modified Barthel index (MBI). Results: In participants with hemiparetic stroke, the MBI, BBS, and MFT scores were significantly higher in the participants who were aware of the therapeutic goal than in those who were unaware (p<0.05). The MBI, BBS, and MFT scores were not significant between the participants who were satisfied with the goal and those who were unsatisfied. Conclusions: This study suggests that having awareness in therapeutic goal-setting could lead to improvement of functional status in those with hemiparetic stroke. This study highlights how goal-setting can have a positive effect on persons with hemiparetic stroke.

Virtual reality (VR) technology has been widely used in post-stroke rehabilitation. However, studies investigating the effectiveness of fully immersive VR technology in gait rehabilitation yielded inconsistent results. This study aims to evaluate the effects of fully immersive VR technology on gait function in the rehabilitation of subacute stroke patients. A total of 40 patients diagnosed with subacute stroke within 2 months of the initial stroke were randomized into two groups, namely the VR group (underwent VR-based training) and the non-VR group (underwent conventional gait rehabilitation training). The timed “Up and Go” (TUG) test, Fugl-Meyer assessment of lower extremity (FMA-LE), modified Barthel index (MBI), and gait spatiotemporal and kinematic parameters measured by a three-dimensional gait analysis system were evaluated at baseline and 3 weeks after the intervention. The results indicated that, in comparison to the non-VR group, the VR group experienced significantly greater improvements in TUG, MBI scores, and cadence on both the affected and unaffected sides (p = 0.050, η2 = 0.100; p = 0.048, η2 = 0.102; p = 0.035, η2 = 0.195; p = 0.038, η2 = 0.188, respectively). Moreover, the majority of gait spatiotemporal and kinematic parameters within the VR group were significantly improved (p < 0.05), whereas only a few gait spatiotemporal and kinematic parameters in the non-VR group showed improvements post-intervention compared with baseline (p < 0.05). This study revealed that fully immersive VR training may be effective in enhancing functional mobility, gait performance, and activities of daily living in subacute stroke patients and may outperform conventional gait rehabilitation training. The effectiveness of fully immersive VR training on the gait function and rehabilitation of stroke patients warrants further research. Trial registration Chinese Clinical Trial Registry ChiCTR1900025375. https://www.chictr.org.cn/showproj.html?proj=41913 .

ObjectiveTo evaluate the effect of prolonged inpatient rehabilitation therapy in subacute stroke patients.MethodWe enrolled 52 subacute stroke patients who had received 3 months of inpatient rehabilitation therapy. Thirty stroke patients received additional inpatient rehabilitation therapy for 3 months and 22 control patients received only home-based care. The evaluation was measured at 3 and at 6 months after stroke occurrence. Functional improvement was measured using the modified motor assessment scale (MMAS), the timed up and go test (TUG), the 10-meter walking time (10 mWT), the Berg balance scale (BBS) and the Korean-modified Barthel index (K-MBI). The health-related quality of life was evaluated using the medical outcome study, 36-item short form survey (SF-36).ResultsIn the experimental group, significant improvements were observed for all parameters at 6 months (p<0.05). However, significant improvements were observed only in MMAS, BBS, and K-MBI at 6 months in the Control group (p<0.05). In comparing the 2 groups, significant difference were observed in all parameters (p<0.05) except 10 meter walking time (p=0.73). The improvement in SF-36 was meaningfully higher in experimental group compared to control group.ConclusionThis study demonstrates that subacute stroke patients can achieve functional improvements and an enhanced quality of life through prolonged inpatient rehabilitation therapy.