Longitudinal changes in physical activity accumulation patterns during 1-year follow-up in stroke survivors.

PURPOSE: Few studies have reported changes in the accumulation patterns of physical activity over a year after stroke. This study characterized the longitudinal changes in physical activity levels and their accumulation patterns for a 1-year follow-up period in stroke survivors. MATERIALS AND METHODS: In this single-center, prospective, longitudinal observational study, 47 stroke survivors were assessed at rehabilitation discharge and at 6 and 12 months post-discharge. Physical activity was evaluated, and measures included the number of steps, walking duration, total number of bouts per day, and intensity (light, moderate-to-vigorous) and spread (short, medium, and long bouts). RESULTS: There were no significant main or interaction effects of time on any physical activity variables. Light physical activity accounted for 90% of all walking bouts and 70% of walking duration. Regarding moderate-to-vigorous physical activity (MVPA), 85% of walking bouts and 35% of walking duration were accumulated in short and medium bouts. The number of long-bout MVPA was three per day. CONCLUSIONS: Physical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period. Accumulating light physical activity and intermittent MVPA is important for maintaining physical activity levels in stroke survivors. These findings will promote a better understanding of disability and rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPhysical activity levels and accumulation patterns were highly stable throughout the 12-month follow-up period.The accumulation of moderate-to-vigorous physical activity in long bouts might be challenging for stroke survivors.Accumulating light physical activity and intermittent moderate-to-vigorous physical activity may be acceptable for stroke survivors.

Weight Change during the Early Phase of Convalescent Rehabilitation after Stroke as a Predictor of Functional Recovery: A Retrospective Cohort Study.

It has been reported that weight gain at discharge compared with admission is associated with improved activities of daily living in convalescent rehabilitation (CR) patients with low body mass index. Here, we investigated whether weight maintenance or gain during the early phase of CR after stroke correlates with a better functional recovery in patients with a wide range of BMI values. We conducted this retrospective cohort study in a CR ward of our hospital and included adult stroke patients admitted to the ward from January 2014 to December 2018. After ~1 month of hospitalization, the patients were classified into weight loss and weight maintenance or gain (WMG) groups based on the Global Leadership Initiative on Malnutrition criteria for weight. We adopted the motor functional independence measure (FIM) gain as the primary outcome. The motor FIM gain tended to be greater in the WMG group but without statistical significance. However, multiple regression analysis showed that WMG was significantly and positively associated with motor FIM gain. In conclusion, weight maintenance or gain in patients during the early phase of CR after stroke may be considered as a predictor of their functional recovery, and nutritional management to prevent weight loss immediately after the start of rehabilitation would contribute to this.

Sex Differences in Physical Activity in People After Stroke: A Cross-sectional Study.

OBJECTIVE: Adequate physical activity after stroke is critical for cardiovascular health. Although sex is a potential factor associated with post-stroke physical activity, its mechanism remains unclear. This study aimed to examine sex differences in human physical activity following stroke. METHOD: A cross-sectional study with 62 participants (men: 42, women: 20) was conducted. Physical activity was measured for three consecutive days using a step activity monitor. The walking durations per day in light physical activity, moderate-to-vigorous physical activity, and total physical activity were calculated. Sex differences in walking duration were compared using Welch's t-tests or Mann-Whitney U tests. RESULTS: Women had a significantly greater walking duration in light physical activity and in total than did the men. In contrast, no significant differences were found in moderate-to-vigorous physical activity. CONCLUSION: This study reported sex differences in the walking duration after stroke. Moreover, it found that women spent more time in low intensity physical activity than men. Our results will be useful for planning interventions to increase physical activity and decrease sedentary behavior after stroke.

Gait training using the Honda Walking Assist Device® for individuals with transfemoral amputation: A report of two cases.

BACKGROUND: Independent walking is important for individuals who have undergone lower limb amputation. Recently, robot-assisted gait training has been widely used for individuals with abnormal gait. However, no study has evaluated the effect of the Honda Walking Assist Device® (HWA) on the gait of patients who have undergone transfemoral (TF) amputation. OBJECTIVE: This study aimed to investigate the safety, feasibility, and effect of gait training using the HWA for individuals who underwent lower limb amputation. METHODS: This study included two elderly patients who underwent TF amputation due to a nontraumatic reason. Gait training interventions using the HWA were performed for a week (5 training sessions). Self-selected walking speed (SWS), step length, cadence, hip kinematic parameters, and symmetricity of single support time ratios during SWS were measured before and after the HWA interventions. RESULTS: SWS, step length, cadence, and hip angle range improved after the HWA interventions in both patients. Symmetricity of single support time ratios and maximum hip extension angle improved in patient 1, but not in patient 2. There were no adverse events in either patient. CONCLUSIONS: Gait training using the HWA was safe and effective for improving the gait of two TF amputees.

Walking activity in community-dwelling stroke survivors within 1 month after discharge from a rehabilitation setting.

Objective: To characterize the pattern of activity accumulation in stroke survivors.Method: Nineteen stroke patients and 19 age-sex-matched healthy adults participated. Step counts were measured using a step activity monitor for 3 d. The steps per day, bouts per day, walking time per day, average steps per bout, and average walking time per bout were calculated in each walking-distance category (short, medium, and long-distance bout) and in total.Results: The total steps per day were 8446 and 11,749 steps in stroke survivors and control participants, respectively. The total steps per day and the total bouts per day for the stroke group were both significantly lower compared with the control group. Significant group differences were found in only the medium-distance range. No significant differences were found in average steps per bout.Conclusion: Fewer number of bouts is a characteristic pattern of walking activity in stroke survivors. In particular, a low number of medium-distance bouts in stroke survivors results in a low number of daily steps when compared with healthy adults. To facilitate physical activity in stroke survivors, not only the total number of bouts per day but the number of bouts of varying lengths must be considered. Implications for rehabilitationFewer number of bouts is a characteristic pattern of walking activity in stroke survivors.Low number of bouts, especially medium-distance bouts, in stroke survivors, results in low number of daily steps when compared with healthy adults.The number of long-distance bouts is important for increasing total daily steps after stroke with mild disability.To facilitate physical activity in stroke survivors, not only the total number of bouts per day but the number of bouts of varying lengths must be considered.

Gait Training Using the Honda Walking Assistive Device® in a Patient Who Underwent Total Hip Arthroplasty: A Single-Subject Study.

BACKGROUND AND OBJECTIVES: The Honda Walking Assistive device® (HWA) is a light and easywearable robot device for gait training, which assists patients' hip flexion and extension movementsto guide hip joint movements during gait. However, the safety and feasibility of robot-assisted gaittraining after total hip arthroplasty (THA) remains unclear. Thus, we aimed to evaluate the safetyand feasibility of this gait training intervention using HWA in a patient who underwent THA. MATERIALS AND METHODS: The patient was a 76-year-old woman with right hip osteoarthritis. Gaittraining using HWA was implemented for 20 sessions in total, five times per week from 1 week to5 weeks after THA. Self-selected walking speed (SWS), step length (SL), cadence, timed up and go(TUG), range of motion (ROM) of hip extension, and hip abduction and extension torque weremeasured preoperatively, and at 1 (pre-HWA), 2, 3, 4, 5 (post-HWA), and 10 weeks (follow-up) afterTHA. The gait patterns at SWS without HWA were measured by using three-dimensional (3D) gaitanalysis and an integrated electromyogram (iEMG). RESULTS: The patient completed 20 gait trainingsessions with no adverse event. Hip abduction torque at the operative side, hip extension torque,SWS, SL, and cadence were higher at post-HWA than at pre-HWA. In particular, SWS, TUG, andhip torque were remarkably increased 3 weeks after THA and improved to almost the same levelsat follow-up. Maximum hip extension angle and hip ROM during gait were higher at post-HWAthan at pre-HWA. Maximum and minimum anterior pelvic tilt angles were lower at post-HWA thanat pre-HWA. The iEMG of the gluteus maximus and gluteus medius in the stance phase were lowerat post-HWA than preoperatively and at pre-HWA. CONCLUSIONS: In this case, the gait training usingHWA was safe and feasible, and could be effective for the early improvement of gait ability, hipfunction, and gait pattern after THA.

Hip prosthesis in sitting posture for bilateral transfemoral amputee after burn injury: a case report.

BACKGROUND: To overcome the challenges of rehabilitation of bilateral transfemoral amputees, we developed a novel "hip prosthesis in the sitting posture." Case Description and Methods: A 64-year-old male bilateral transfemoral amputee was transferred for rehabilitation 4 months following a burn injury. His wounds remained unhealed for 20 months; thus, he was unable to participate in standing training with the standard prosthetic sockets. Hip prosthesis in the sitting posture has very little friction between the sockets and residual limbs, which facilitated our patient to begin standing and walking exercises. Findings and Outcomes: The patient's refractory wounds healed 1 month after initiating exercises using hip prosthesis in the sitting posture, and he could begin rehabilitation with the standard prostheses. DISCUSSION AND CONCLUSION: Hip prosthesis in the sitting posture enabled a bilateral transfemoral amputee with unhealed residual limbs to stand, walk, and begin balance training. Hip prosthesis in the sitting posture is an effective temporary prosthesis to prevent disuse until wounds are healed and to continue rehabilitation with standard prostheses. Clinical relevance Hip prosthesis in the sitting posture is useful for bilateral transfemoral amputees with unhealed residual limbs after burn injuries to prevent disuse and maintain motivation for walking.