Steps After Stroke

Shaughnessy, Marianne; Michael, Kathleen M.; Sorkin, John D.; Macko, Richard F.

doi:10.1161/01.str.0000166202.00669.d2

Cited by 123 publications

(72 citation statements)

References 9 publications

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“…This study contributes to the limited findings on ambulation recovery across the subacute phase of stroke, providing further evidence that volume of activity can improve over this time 6,7 . Contrary to previous reports of a plateau in ambulation activity recovery at six months 7 , the current study demonstrated a greater improvement in ambulation activity between one and six months than between one and three months after hospital discharge.…”

Section: Discussionmentioning

confidence: 64%

“…10,000 steps per day) 5 . However, observation of change in ambulation activity behaviours from the subacute (24 hours to 6-months post-stroke) to the chronic phase (> 6-months post-stroke) of stroke recovery is limited and variable 4,6,7 .…”

Section: Introductionmentioning

confidence: 99%

“…These studies report a range of findings, from no change in daily step counts across six weeks after hospital discharge post-stroke 4 , to improvements of approximately 1200 steps/day (80% increase) across twelve weeks after hospital discharge 6,7 , with little change in daily ambulation activity after this time 7 . This variation in the literature is likely due to many factors, including the devices used, the time points chosen and measures used to characterise activity.…”

Section: Introductionmentioning

confidence: 99%

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Recovery of ambulation activity across the first six months post-stroke

2016

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word count: 245 Word count: 2754 Highlights Stroke survivors increase walking activity over the first 6 months post-discharge.  Stroke survivors increase daily sitting time over the first 6-monts post-discahrge.  Stroke survivors spend least time in long duration and high intensity activity.  Interventions to target activity should be considered 3-months post-discharge. AbstractStroke survivors commonly adopt sedentary activity behaviours by the chronic phase of recovery. However, the change in activity behaviours from the subacute to chronic phase of stroke is variable. This study explored the recovery of ambulation activity (volume and bouts) at one, three and six months after hospital discharge post-stroke. A total of 42 stroke survivors were recruited at hospital discharge and followed up one, three and six months later. At follow-up, ambulation activity was measured over four days using the ActivPAL TM accelerometer. Measures included volume of activity and frequency and intensity of ambulation activity bouts per day. Linear mixed effects modelling was used to determine changes over time. There was wide variation in activity. Total step counts across all time points were below required levels for health benefits (mean 4592 SD 3411). Most activity was spread across short bouts. While most number of bouts was of low intensity, most time was spent in moderate intensity ambulation across all time points. Daily step count and time spent walking and sitting/lying increased from one month to three and six months. The number of and time spent in short and medium duration bouts increased from one to six months. Time in long duration bouts increased at three months only. Time spent in moderate intensity ambulation increased over time. No change was observed for any other measures. In future, it would be valuable to identify strategies to increase engagement in activity behaviours to improve health outcomes after stroke.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recovery of ambulation activity across the first six months post-stroke

2016

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“…In previous studies of nondisabled individuals [19], older adults [20], and individuals with stroke [15], the SAM demonstrated greater than 95 percent accuracy and remarkably stable output during repeated testing (correlation ranges 0.84-0.98). In addition, the SAM is sensitive to changes in walking performance in individuals poststroke for up to 3 months postdischarge from acute rehabilitation, even in the absence of change in other ambulation outcome measures [21].…”

Section: Methodsmentioning

confidence: 99%

Step Activity Monitor: Accuracy and test-retest reliability in persons with incomplete spinal cord injury

Bowden¹,

Behrman²

2007

JRRD

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Abstract-Recovery of walking after incomplete spinal cord injury (iSCI) is a common focus of rehabilitation, but few measurement tools capture walking performance outside the clinic or laboratory. This study determined the accuracy and testretest reliability of the Step Activity Monitor (SAM), a microprocessor-driven accelerometer that measures walking activity. We evaluated 11 individuals with iSCI during replicate 6-minute walk tests (6MWTs) and 10-meter walk tests (10mWTs) scheduled <1 week apart. The SAM was 97% accurate compared with hand-tallied step counts. SAM values were stable across repeated walking performances (intraclass correlation coefficient = 0.97-0.99). Standard error of measurement values were 6.0 steps and 0.8 steps for the 6MWT and 10mWT, respectively. Ninety-five percent confidence intervals were 203.7 to 177.0 steps for the 6MWT and 16.1 to 12.7 steps for the 10mWT. The SAM is an accurate and reliable device for capturing walking activity in individuals with iSCI.

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“…Hence, conventional subacute stroke rehabilitation likely does not provide adequate exercise to reverse profound deconditioning [16]. Following completion of subacute stroke rehabilitation, patients with stroke had extremely low activity levels that further contribute to deconditioning and poor cardiovascular health as measured by microprocessor-linked step activity monitoring [23][24]. We report that community-dwelling individuals with chronic stroke take a mean of only 1,400 steps/day, with only 83 steps/day at a higher walking intensity (>30 steps/min).…”

Section: Problem Of Poststroke Deconditioningmentioning

confidence: 99%

Task-oriented treadmill exercise training in chronic hemiparetic stroke

Ivey

Hafer‐Macko²,

Macko³

2008

JRRD

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Abstract-Patients with stroke have elevated hemiparetic gait costs secondary to low activity levels and are often severely deconditioned. Decrements in peak aerobic capacity affect functional ability and cardiovascular-metabolic health and may be partially mediated by molecular changes in hemiparetic skeletal muscle. Conventional rehabilitation is time delimited in the subacute stroke phase and does not provide adequate aerobic intensity to reverse the profound detriments to fitness and function that result from stroke. Hence, we have studied progressive full body weight-support treadmill (TM) training as an adjunct therapy in the chronic stroke phase. Task-oriented TM training has produced measurable changes in fitness, function, and indices of cardiovascular-metabolic health after stroke, but the precise mechanisms for these changes remain under investigation. Further, the optimal dose of this therapy has yet to be identified for individuals with stroke and may vary as a function of deficit severity and outcome goals. This article summarizes the functional and metabolic decline caused by inactivity after stroke and provides current evidence that supports the use of TM training during the chronic stroke phase, with protocols and inclusion/exclusion criteria described. Our research findings are discussed in relation to associated research.Key words: aerobic activity, ambulatory function, cardiovascular disease risk, exercise training, hemiplegia, metabolic health, physical deconditioning, rehabilitation, stroke, treadmill. PROBLEM OF POSTSTROKE DECONDITIONINGStroke is a leading cause of disability [1][2][3][4], with residual neurological deficits that persistently impair function and lead to profound physical deconditioning [5][6]. By limiting mobility and increasing fall risk, the hemiparetic gait that accompanies chronic stroke promotes a sedentary lifestyle, which leads to disability through deconditioning and "learned non-use" [7][8]. Peak cardiovascular fitness levels following hemiparetic stroke are roughly half those of age-matched sedentary individuals [5,[9][10]. Further, the energy requirements of hemiparetic gait are elevated by 55 to 100 percent compared with age-matched control subjects [11][12]. This detrimental combination of poor peak exercise capacity and elevated energy demands for hemiparetic gait is termed diminished physiological fitness reserve [13]. The cardiovascular deconditioning coupled with the secondary body composition abnormalities that follow stroke Abbreviations: ACSM = American College of Sports Medicine, ADL = activities of daily living, BMI = body mass index, CVD = cardiovascular disease, ECG = electrocardiogram, HR = heart rate, HRR = HR reserve, IGT = impaired glucose tolerance, MHC = myosin heavy chain, T2DM = type 2 diabetes mellitus, TM = treadmill, TNF-α = tumor necrosis factor-α, WIQ = Walking Impairment Questionnaire, VA = Department of Veterans Affairs, VO 2 = peak oxygen consumption.

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Steps After Stroke

Cited by 123 publications

References 9 publications

Recovery of ambulation activity across the first six months post-stroke

Recovery of ambulation activity across the first six months post-stroke

Step Activity Monitor: Accuracy and test-retest reliability in persons with incomplete spinal cord injury

Task-oriented treadmill exercise training in chronic hemiparetic stroke

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