Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke?

Mahendran, Niruthikha; Kuys, Suzanne; Brauer, Sandra G.

doi:10.1080/09638288.2018.1508513

Cited by 19 publications

(31 citation statements)

References 40 publications

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“…Walking endurance, balance, and motor function are the strongest predictors of community walking activity ( Fulk et al, 2017 ). Walking endurance, as measured by the 6MWT, was the strongest individual predictor of community walking activity ( Fulk et al, 2017 ; Mahendran, Kuys, & Brauer, 2020 ). Research shows that the 6MWT is a better predictor of community ambulation due to the distance requirements for community walking ( Andrews et al, 2010 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of robotic exoskeleton gait training during acute stroke on functional ambulation

Karunakaran

Gute

Ames

et al. 2021

NRE

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BACKGROUND: Stroke is a leading cause of disability resulting in long-term functional ambulation deficits. Conventional therapy can improve ambulation, but may not be able to provide consistent, high dose repetition of movement, resulting in variable recovery with residual gait deviations. OBJECTIVE: The objective of this preliminary prospective investigation is to evaluate the ability of a robotic exoskeleton (RE) to provide high dose gait training, and measure the resulting therapeutic effect on functional ambulation in adults with acute stroke. METHODS: Participants (n = 14) received standard of care (SOC) and RE overground gait training during their scheduled physical therapy (PT) sessions at the same inpatient rehabilitation facility. The outcome measures included distance walked during their PT training sessions (RE and SOC), and functional ambulation measures (10-meter walk test (10MWT), 6-minute walk test (6 MWT), and timed up and go (TUG)). RESULTS: The average total distance walked during RE and the average distance per RE session was significantly higher than SOC sessions. Total walking distance during PT (RE+SOC) showed a strong positive correlation to the total number of steps during RE sessions and number of RE sessions. All functional ambulation measures showed significant improvement at follow-up compared to baseline. The improvement in functional ambulation measures showed a positive correlation with the increase in number of RE gait training sessions. CONCLUSION: The RE can be utilized for inpatient rehabilitation in conjunction with SOC gait training sessions and may result in improved functional ambulation in adults with acute stroke. This preliminary research provides information on the ability of the robotic exoskeleton to provide high dose therapy and its therapeutic effect on functional ambulation in adults with acute stroke during inpatient rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Effect of robotic exoskeleton gait training during acute stroke on functional ambulation

Karunakaran

Gute

Ames

et al. 2021

NRE

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“…In the present study, the majority of the participants reported walking as the mostly preferred exercise and had walking speeds compatible with community walking. Considering that physical activity levels after stroke are associated with walking speed [26,27], gait training should be early implemented to increase physical activity levels and engagement in exercise programs. However, a recent study with individuals with stroke with similar characteristics in Brazil showed that lack of places to exercise was reported as the second most important barrier, followed by long distances from exercise venues [8].…”

Section: Discussionmentioning

confidence: 99%

Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke

Caetano

Pacheco

Ribeiro-Samora

et al. 2020

Stroke Research and Treatment

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Aim. To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. Methods. For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. Results. Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. Conclusion. The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.

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“…Prestroke variables were comorbidities noted in the medical history (hypertension, ischaemic heart disease, hypercholesterolaemia, diabetes mellitus, atrial fibrillation; all defined as present or absent). Stroke-related variables were stroke severity (National Institutes of Health Stroke Scale, NIHSS), 22 considered as a continuous variable and in subgroups (mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16), severe (>16)), stroke type (ischaemic, haemorrhagic), Oxfordshire Stroke Classification 23 subgroups (total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), lacunar infarct (LACI), intracerebral haemorrhage (ICH)), ischaemic stroke location (large cortical, small cortical, hemispheric lacunar, brainstem, cerebellum, other, no infarct on imaging), stroke hemisphere (left, right, brainstem, not evident on imaging, unknown) and thrombolysis treatment with recombinant tissue plasminogen activator (yes, no). Stroke-related variables of stroke type, ischaemic stroke location and stroke hemisphere were reported based on information from routine neuroimaging (CT or MRI) performed at the local hospital.…”

Section: Variables Of Interestmentioning

confidence: 99%

Factors associated with time to independent walking recovery post-stroke

Kennedy

Bernhardt

Чурилов

et al. 2021

J Neurol Neurosurg Psychiatry

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BackgroundPast studies have inconsistently identified factors associated with independent walking post-stroke. We investigated the relationship between pre-stroke factors and factors collected acutely after stroke and number of days to walking 50 m unassisted using data from A Very Early Rehabilitation Trial (AVERT).MethodsThe outcome was recovery of 50 m independent walking, tested from 24 hours to 3 months post-stroke. A set of a priori defined factors (participant demographics: age, sex, handedness; pre-stroke: hypertension, ischaemic heart disease, hypercholesterolaemia, diabetes mellitus, atrial fibrillation; stroke-related: stroke severity, stroke type, ischaemic stroke location, stroke hemisphere, thrombolysis) were investigated for association with independent walking using a cause-specific competing risk Cox proportional hazards model. Respective effect sizes are reported as cause-specific adjusted HR (caHR) adjusted for age, stroke severity and AVERT intervention.ResultsA total of 2100 participants (median age 73 years, National Institutes of Health Stroke Scale 7, <1% missing data) with stroke were included. The median time to walking 50 m unassisted was 6 days (IQR 2–63) and 75% achieved independent walking by 3 months. Adjusted Cox regression indicated that slower return to independent walking was associated with older age (caHR 0.651, 95% CI 0.569 to 0.746), diabetes (caHR 0.836, 95% CI 0.740 to 0.945), severe stroke (caHR 0.094, 95% CI 0.072 to 0.122), haemorrhagic stroke (caHR 0.790, 95% CI 0.675 to 0.925) and right hemisphere stroke (caHR 0.796, 95% CI 0.714 to 0.887).ConclusionOur analysis provides robust evidence for important factors associated with independent walking recovery. These findings highlight the need for tailored mobilisation programmes that target subgroups, in particular people with haemorrhagic and severe stroke.

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Which impairments, activity limitations and personal factors at hospital discharge predict walking activity across the first 6 months poststroke?

Cited by 19 publications

References 40 publications

Effect of robotic exoskeleton gait training during acute stroke on functional ambulation

Effect of robotic exoskeleton gait training during acute stroke on functional ambulation

Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke

Factors associated with time to independent walking recovery post-stroke

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