Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

OBJECTIVES: To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter. METHOD: Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference. RESULTS: The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10). CONCLUSIONS: The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion. .

Percepção de hemiplégicos crônicos sobre o uso de dispositivos auxiliares na marcha / Perception of patients with chronic hemiplegia regarding the use of assistive walking devices

OBJETIVO: Avaliar a percepção de hemiplégicos crônicos sobre o uso de dispositivos auxiliares (DA) na marcha. MÉTODOS: A partir de um banco de dados de 360 hemiplégicos, foram recrutados 23 indivíduos que utilizavam DA e preenchiam os critérios de inclusão. A média de idade foi de 58,4 anos, tempo pós-acidente vascular encefálico de 80,8 meses e tempo de uso do DA de 67,6 meses. Para avaliar a percepção dos participantes, utilizou-se um questionário padronizado, composto por cinco questões: impacto do DA na habilidade para descarregar peso no membro parético; impacto na habilidade para movimentar o membro parético; impacto na confiança; impacto na segurança; e impacto no jeito de caminhar. As respostas possíveis eram "melhorou", "não alterou" ou "piorou". RESULTADOS: Quatorze indivíduos utilizavam bengalas e nove utilizavam muletas canadenses; 21 (91,3 por cento) utilizavam DA somente em vias públicas e dois (8,7 por cento) utilizavam DA também em ambiente domiciliar. A percepção em relação ao uso do DA foi positiva nas quatro primeiras questões (6,87 < χ2< 29,83; 0,0001 < P < 0,03), com relatos de melhora na descarga de peso (82,6 por cento), na habilidade de movimentar o membro parético (39,1 por cento), na confiança para caminhar (82,6 por cento) e na segurança (86,9 por cento). Não foram observadas diferenças significativas para o item jeito de caminhar (χ2= 1,09; P = 0,30). CONCLUSÕES: A percepção dos indivíduos hemiplégicos crônicos foi positiva em relação ao uso de DA para deambulação, sugerindo que esses dispositivos podem melhorar a mobilidade e a independência durante as atividades de vida diária.

OBJECTIVE: To assess the perception of patients with chronic hemiplegia regarding the use of assistive walking devices (AWD). METHODS: Twenty-three individuals who met the inclusion criteria and used AWD were recruited from a database of 360 stroke survivors. Their mean age was 58.4 years, mean time since stroke was 80.8 months, and mean time using AWD was 67.6 months. To assess the participants' perception, was used a standardized questionnaire covering the impact of AWDs on five aspects: weight-bearing on the paretic limb; ability to move the paretic limb; confidence; safety; and walking style. Possible answers were "improved," "unchanged," or "decreased." RESULTS: Fourteen individuals used canes and nine used elbow crutches; 21 (91.3 percent) used AWDs on public roads and only two (8.7 percent) used AWDs at home. The perception regarding the use of AWDs were positive in the first four questions (6.87 < χ2 < 29.83; 0.0001 < P < 0.03), with reports of improvement in weight-bearing (82.6 percent), ability to move the paretic limb (39.1 percent), confidence (82.6 percent), and safety (86.9 percent). No significant differences were found in terms of walking style (χ2 = 1.09; P = 0.30). CONCLUSIONS: The perception of chronic hemiplegic subjects regarding the use of AWD were positive, suggesting that these devices can improve mobility and independence in activities of daily living.

Relationship between walking performance and types of community-based activities in people with stroke: an observational study / Relação entre desempenho da marcha e tipos de atividades na comunidade após acidente vascular encefálico

OBJECTIVES: To examine the relationship between clinical walking performance and amount and type of community activity in people after stroke. METHODS: A cross-sectional observational study of 14 people with stroke living in Sydney and able to walk was carried out. Demographics (such as age, gender, side of stroke, time since stroke, presence of spouse) and aspects of walking performance (such as speed, capacity, automaticity, and stairs ability) were measured. People with stroke were observed for at least five hours while they carried out activities in the community. These activities were then categorized into four types: domestic intrinsic, domestic extrinsic, leisure without contact, and leisure with contact activity. RESULTS: No relationship was found between walking performance and the amount of community activity. There was no relationship between walking performance and total time spent on domestic intrinsic activity. Walking speed and stairs ability were significantly correlated with leisure with contact activity (r=0.56, p=0.04, and r=0.57, p=0.03 respectively) and inversely correlated with leisure without contact (r=-0.72, p<0.01, and r=-0.66, p=0.01 respectively). Walking capacity was also inversely correlated with leisure without contact (r=-0.77, p<0.01). Only stairs ability was significantly correlated with domestic extrinsic activity (r=0.77, p<0.01). CONCLUSIONS: Findings suggest that if walking performance is poor after stroke, activities at home and in the community will be limited, so that people may become housebound and isolated from society.

OBJETIVOS: Examinar a relação entre o desempenho da marcha e a quantidade e tipo de atividades na comunidade em indivíduos após acidente vascular encefálico (AVE). MÉTODOS: Realizou-se um estudo observacional transversal em 14 indivíduos com AVE, aptos a deambular, residentes em Sydney. Resultados demográficos (como idade, gênero, lado hemiparético, tempo desde o AVE, estado civil) e aspectos de desempenho da marcha (como velocidade, resistência, automaticidade e habilidade de usar escadas) foram avaliados. Os indivíduos foram observados por pelo menos cinco horas durante suas atividades na comunidade. Essas atividades foram então categorizadas em quatro tipos: intrínseco-doméstica, extrínseco-doméstica, atividade de lazer com contato e atividade de lazer sem contato. RESULTADOS: Nenhuma relação foi encontrada entre desempenho da marcha e quantidade de atividades na comunidade. Também não houve relação entre desempenho da marcha e tempo gasto em atividade intríseco-doméstica. Velocidade da marcha e habilidade no uso de escadas correlacionaram-se significativamente com atividade de lazer com contato (r=0,56, p=0,04 e r=0,57, p=0,03, respectivamente) e correlacionaram-se inversamente com atividade de lazer sem contato (r=-0,72, p<0,01, e r=-0,66, p=0,01, respectivamente). Desempenho da marcha correlacionou-se inversamente com atividade de lazer sem contato (r=-0,77, p<0,01). Apenas habilidade no uso de escadas correlacionou-se significativamente com atividade extrínseco-doméstica (r=0,77, p<0,01). CONCLUSÕES: Os resultados sugerem que se o desempenho da marcha fica comprometido após o AVE, as atividades em casa e na comunidade serão limitadas e, com isso, os indivíduos podem se tornar confinados à casa e isolados da sociedade.