No abstract

Knee muscle strength is a moderate to strong predictor of walking ability in individuals with chronic mild to moderate poststroke hemiparesis. Walking ability influences perceived participation, but the strengths of the relations indicate that other factors are also important.

The BBS and the SLS are reproducible measurements in patients with chronic stroke, but only the BBS is sensitive enough to follow changes over time or after an intervention. The SLS is strongly related to the BBS and can be used as an independent test to measure upright postural control after a stroke.

Objective: To assess the intra-rater (between occasions) test-retest reliability of isokinetic knee muscle strength measurements in subjects with chronic poststroke hemiparesis and to define limits for the smallest change that indicates real (clinical) improvements for stroke patients. Subjects: Fifty men and women (mean age 589±6.4 years) 6=±46 months post stroke, able to walk at least 300 m with or without a unilateral assistive device. Methods: Maximal concentric knee extension and flexion contractions at 608/s and 1208/s, and maximal eccentric knee extension contractions at 608/s, with the paretic and nonparetic limbs, were performed seven days apart using a Biodex dynamometer. Measures: Reliability of the maximum peak torque measurements was evaluated with the intraclass correlation coefficient (ICC2,1), the Bland and Altman analyses, the standard error of measurement (SEM and SEM%) and the smallest real difference (SRD and SRD%). Results: Test retest agreements were high (ICC2,1 0.89-0.96) with no discernible systematic differences between limbs, angular velocities and modes. The SEM%, representing the smallest change that indicates a real (clinical) improvement for a group of subjects, was relatively small (8-20%). The SRD%, representing the smallest change that indicates a real improvement for a single subject ranged from 26% to 33% for concentric knee extension, from 39% to 55% for concentric knee flexion, and from 22% to 25% for eccentric knee extension. Conclusion: Isokinetic knee muscle strength can be reliably measured and used to detect real improvements following an intervention for single subjects as well as for groups of subjects with chronic mild to moderate hemiparesis after stroke.

Objectives: To evaluate the long-term benefits of progressive resistance training in chronic stroke. Design: A 4-year follow-up of a randomized controlled trial of progressive resistance training. Subjects: Eighteen women and men (mean age 66 (standard deviation 4) from the original group of 24 post-stroke participants. Methods: The training group (n = 11) had participated in supervised progressive resistance training of the knee extensors and flexors (80% of maximum) twice weekly for 10 weeks, whereas the control group (n = 7) had continued their usual daily activities. Muscle strength was evaluated isotonically and isokinetically (60º/s; Biodex), muscle tone with the Modified Ashworth Scale, gait performance by the Timed Up and Go test, the Fast Gait Speed test and 6-Minute Walk test, and perceived participation with the Stroke Impact Scale (Participation domain). Results: Four years after the intervention, the improvements in muscle strength in the training group were maintained, and there was no reduction in strength in the control group. Compared with baseline there were still significant betweengroup differences for both isotonic and isokinetic strength. No significant between-group differences were found in muscle tone, gait performance or perceived participation. Conclusion:The results indicate that there is a long-term benefit of progressive resistance training in chronic stroke. This implies that progressive resistance training could be an effective training method to improve and maintain muscle strength in a long-term perspective.

Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.

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Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.