Exercise stress testing in subacute stroke patients using a combined upper- and lower-limb ergometer.

OBJECTIVE: To assess functional cardiopulmonary exercise tolerance in a subset of patients with residual neurologic deficits after stroke by exercise stress testing using the Power Trainer, a combined upper- and lower-limb ergometer. DESIGN: Prospective, observational study using a convenience sample. SETTING: Clinical locomotor laboratory in a tertiary rehabilitation hospital. PARTICIPANTS: Thirty subjects undergoing rehabilitation an average of 7.3 weeks after stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Percentage of age-predicted maximal heart rate (APMHR) achieved and rate-pressure product (RPP). RESULTS: Thirty subjects completed stress tests. Twelve of the 30 subjects were taking beta-blocker medications. Mean maximum heart rate +/- standard deviation achieved was 119+/-21 beats/min, equal to 75%+/-11% of APMHR. Ten subjects achieved 85% of APMHR or greater. Those not taking a beta-blocker attained 80%+/-10% of APMHR. The percentage increase in RPP from rest to maximal exercise for the whole group was 117%+/-44%. Four subjects developed cardiopulmonary signs or symptoms. Exercise prescriptions were provided to patients using the Karvonen formula. Overall subject satisfaction with the Power Trainer was high. CONCLUSION: The Power Trainer can be used safely to assess cardiopulmonary exercise tolerance in a select subset of patients with neurologic impairments secondary to stroke. This information can be extrapolated for proper exercise prescription and may contribute to the investigation of coronary artery disease in this high-risk population.

Wheelchair-skill performance: controlled comparison between people with hemiplegia and able-bodied people simulating hemiplegia.

OBJECTIVE: To test the hypothesis that able-bodied people simulating hemiplegia (using the hemiplegic-propulsion pattern [1 arm and 1 leg]) have as much difficulty performing wheelchair skills as people with hemiplegia. DESIGN: Single-blind, controlled comparison of 2 groups. SETTING: Kinesiologic laboratory in a rehabilitation center. PARTICIPANTS: Twenty wheelchair users with hemiplegia (HP group) (median age, 68y; 80% men) and 20 able-bodied participants (AB group) (median age, 67y; 75% men). INTERVENTIONS: The participants in the AB group simulated hemiplegia and received a brief period of wheelchair skills training. Participants in both groups were asked to attempt the 50 skills of the Wheelchair Skills Test, version 2.4 (WST 2.4). MAIN OUTCOME MEASURES: Total and subtotal percentage scores on the WST 2.4 and success rates for the 50 individual skills. RESULTS: The mean percentage WST scores for the AB group were significantly greater than those for the HP group for the total WST scores ( P <.001), the indoor skill level ( P <.001), and the community skill level ( P <.001), but the advanced skill level scores were 0% for both groups. On the individual skills, the AB group had success rates at least 25% higher than the HP group for 13 (26%) of the skills. Both groups were generally successful (>/=75% success rate) on 21 skills (42%). Both groups experienced difficulties (

Electrophysiological assessment of language function following stroke.

OBJECTIVE: Event-related brain potentials (ERPs) were used to assess language function after stroke and demonstrate that it is possible to adapt neuropsychological tests to evaluate neurocognitive function using ERPs. Prior ERP assessment work has focused on language in both healthy individuals and case studies of aphasic neurotrauma patients. The objective of the current study was to evaluate left-hemisphere stroke patients who had varying degrees of receptive language impairment. It was hypothesized that ERPs would assess receptive language function accurately and correlate highly with the neuropsychological data. METHODS: Data were collected from 10 left-hemisphere stroke patients; all were undergoing rehabilitation at the time of testing. Each patient received a battery of neuropsychological tests including the Peabody Picture Vocabulary Test-Revised (PPVT-R; Minnesota: American Guidance Service, 1981). ERPs were recorded during a computerized PPVT-R, in which pictures are presented followed by digitized spoken words that are either congruent or incongruent with the pictures. RESULTS AND CONCLUSION: Incongruent spoken words within an individual's vocabulary level elicited well-known ERP components. One of the components (the N400) could be utilized as a marker of intact semantic processing. The ERP results were subsequently quantified and N400 derivative scores correlated highly with the neuropsychological findings. The results provided a clear demonstration of the efficacy of ERP-based assessment in a neurological patient group. SIGNIFICANCE: Language function in stroke patients can be evaluated, independent of behavior, using electrophysiological measures that correlate highly with traditional neuropsychological test scores.

Limb activation effects in hemispatial neglect.

OBJECTIVE: To assess the efficacy of passive and active limb movement to improve visual scanning in patients with hemispatial neglect. DESIGN: Before-after trial: behavioral analyses of a case series. SETTING: Stroke rehabilitation unit in a tertiary care hospital. PARTICIPANTS: Nine individuals with right-hemisphere stroke (mean time poststroke, 19.5 mo) and left-sided neglect, as assessed by the Sunnybrook Bedside Neglect Battery. INTERVENTION: Active left limb movement (button push; n=3) or passive left limb movement (n=8) with functional electric stimulation (FES) administered during visual scanning testing. MAIN OUTCOME MEASURES: Performance on visual scanning tests involving naming of letters and numbers. RESULTS: Both active and passive movement significantly improved target detection on the left side, but not on the right side, on the visual scanning task. Positive results were seen in 2 of 3 active movement patients and 6 of 8 passive movement patients. CONCLUSIONS: Both active and FES-stimulated passive movements are potential techniques for the treatment of hemispatial neglect.