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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of the supine training position to enhance aerobic training was evaluated in a 10-week upper-body exercise study. Fourteen subjects with quadriplegia (QD) were matched on initial peak power output (PO) values and then randomly assigned to either a supine (SUP, n = 7) or sitting (SIT, n = 7) training group. Peak VO2 and PO were measured pretraining and posttraining in both the supine and sitting positions. There were significant (p < .01) increases in peak VO2 (720 to 780 mL.min-1) and PO (29.3 to 33.3W) with training. Although the SIT group exhibited a small training effect size (0.1), while the SUP group exhibited a moderate effect size (0.6), the interaction between time and training group failed to reach significance (p = .07) because of a large injury level-related variation in VO2. The training effect achieved by the SUP group generalized to the sitting position, as their peak VO2 increased 80mL.min-1 in the sitting position. Endurance improved (p < .0001) in all subjects, with time to exhaustion increasing from 52min to 135min over the 10 weeks of training. The sum of 4 skinfolds decreased (p < .05) from 67.5 to 61.0mm. The lack of change in stroke volume at rest and at 50% of peak PO suggests that an inotropic adaptation of the heart, commonly observed in subjects without SCI, did not occur in this population. However, a 4.7bpm increase (p < .01) in resting heart rate (HR) and a near significant increase (p = .07) in peak HR from pretraining to posttraining suggests a training-induced chronotropic adaptation of the heart. Although improvements in aerobic capacity can be achieved by training in either supine or sitting positions, the training effect size was larger in the supine position. Improvements in SV were not observed in either training position; this may be because of low absolute workloads were used. Central cardiovascular adaptation may occur in subjects with QD but changes are reflected as chronotropic and not inotropic adaptations.
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PMID:Effect of body training position on outcomes of an aerobic training study on individuals with quadriplegia. 784 72

An effective method was sought to decrease the incidence of urinary tract infections acquired by hospitalized rehabilitation patients requiring catheterization. The purpose of this study was to determine whether there was a difference in the incidence of urinary tract infections that occurred following use of two types of intermittent catheterization techniques: open catheterization and closed catheterization. The incidence of infection in both the control (open catheterization) and experimental (closed catheterization) groups was analyzed. In the control group, 9 of 14 patients (5 stroke, 4 spinal cord injured [SCI]) completed all four urine tests. Two patients developed a 20,000 colony count of enterococcus on the fourth urine sample using open catheterization. In the experimental group, 11 (4 stroke, 7 SCI) out of 16 patients maintained colony counts below 100,000 organisms per ml; one patient had a 16,000 colony count using closed catheterization. Qualitative data revealed that patients had a positive response to the closed system.
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PMID:A comparison of open and closed catheterization techniques in rehabilitation patients. 843 Feb 60

Electrical stimulation-induced leg muscle contractions provide a useful model for examining the role of leg muscle neural afferents during low-intensity exercise in persons with spinal cord-injury and their able-bodied cohorts. Eight persons with paraplegia (SCI) and 8 non-disabled subjects (CONTROL) performed passive knee flexion/extension (PAS), electrical stimulation-induced knee flexion/extension (ES) and voluntary knee flexion/extension (VOL) on an isokinetic dynamometer. In CONTROLs, exercise heart rate was significantly increased during ES (94 +/- 6 bpm) and VOL (85 +/- 4 bpm) over PAS (69 +/- 4 bpm), but no changes were observed in SCI individuals. Stroke volume was significantly augmented in SCI during ES (59 +/- 5 ml) compared to PAS (46 +/- 4 ml). The results of this study suggest that, in able-bodied humans, Group III and IV leg muscle afferents contribute to increased cardiac output during exercise primarily via augmented heart rate. In contrast, SCI achieve raised cardiac output during ES leg exercise via increased venous return in the absence of any change in heart rate.
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PMID:Cardiovascular and metabolic responses to electrical stimulation-induced leg exercise in spinal cord injury. 947 Apr 2

Functional electrical stimulation (FES) of upper limbs can be used for the recovery of some hand functions on patients with CNS lesions. This study deals with the control of FES by means of myoelectrical activity detected from voluntarily activated paretic muscles. The specific aim of this paper is to evaluate the accuracy of myoelectrical control in terms of produced force and movement. For this purpose, a specific device called myoelectrical controlled functional electrical stimulator (MeCFES) has been developed and applied to six tetraplegic patients with a spinal cord lesion and one stroke hemiplegic patient. Residual myoelectric signals from the paretic wrist extensor (m. extensor carpi radialis, ECR) have been used to control stimulation of either the wrist extension (i.e., the same muscle) or thumb flexion. A tracking test based on a visual feedback of the produced force or movement compared to a reference target trajectory was used to quantify control accuracy. A comparison was made between the tracking performances of each subject with and without the MeCFES and the learning process for two of the subjects were observed during consecutive sessions. Results showed that the wrist extension was improved in three out of five C5 SCI patients and the thumb flexion was largely increased in one incomplete C3 SCI patient. The hemiplegic patient showed limited thumb control with the MeCFES but indicated the possibility of a carry over effect. It was found that a low residual natural force resulted in a less accurate movement but also with a large increase (up to ten times) of the muscle output. On the contrary, persons with a medium residual force obtained a smaller amplification of muscle force with a higher tracking accuracy.
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PMID:A pilot study of myoelectrically controlled FES of upper extremity. 1147 69

The relationships between social competence and cardiovascular reactivity were evaluated in 180 children (ages 8-17; 52% female; 53% Caucasian). Participants performed a social task (Social Competence Interview [SCI]) and 2 nonsocial tasks while reactivity measures were obtained. Social competence was coded from SCI audiotapes. Among adolescents, higher scores on the Acceptance-Affiliation subscale were associated with increased heart rate (HR) and blood pressures and with decreased HR variability during the SCI. Among boys, greater Acceptance-Affiliation scores were associated with increased vascular reactivity during the SCI. During the nonsocial tasks, higher Self-Defensiveness and Expressiveness scores were associated with increased cardiac output and stroke volume among African American children. Personal strivings and expressive skills do matter for understanding cardiovascular responses in children.
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PMID:Cardiovascular reactivity during social and nonsocial stressors: do children's personal goals and expressive skills matter? 1184 40

BWSTT has become an accepted standard of care in gait rehabilitation methods. This type of locomotor training has many functional benefits, but the physical labor costs are considerable. To reduce therapist effort and improve the repeatability of locomotor training, three groups have developed commercially available robotic devices for assisted stepping. The purpose of these robotic devices is to augment locomotor rehabilitation by decreasing therapist manual assistance, increasing the amount of stepping practice, while decreasing therapist effort. Current clinical studies have yielded positive and promising results in locomotor rehabilitation inpatients with neurologic impairments of stroke or SCI. The potential benefits from robotic technology are significant for clinical use and research. As further research is conducted, rehabilitation therapists and patient outcomes will be able to contribute to the development of current and future technologies.
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PMID:Robotic orthoses for body weight-supported treadmill training. 1651 49

Loss of function after SCI, ABI or stroke has a marked affect on ones quality of life. Return of function has been a long-standing goal of physical and occupational therapy. Repeated motor practice has been identified as crucial for motor recovery. The development of a robotic device for neuromotor rehabilitation and upper extremity neuromuscular system recovery is described. The actuator mechanism allows free motion when possible, and provides programmable therapeutic levels of resistance. The sensor system allows characterization of the applied forces, and accurate measurement of the range of motion of the joint. The control system provides real time feedback of actuator commands based on sensor data, calibration routines, and operational modes.
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PMID:Exoskeleton for forearm pronation and supination rehabilitation. 1727 Aug 37

Successful motor rehabilitation of stroke, TBI and SCI subjects requires an intensive and task-specific therapy approach. Budget constrains limit a hand-to-hand therapy approach, so that intelligent machines may offer a solution to further promote motor recovery and to better understand motor control. This new field of automated or robot-assisted motor rehabilitation has emerged since the nineties. The article presents clinically viable devices for the upper and lower extremity rehabilitation, which have been developed by our group. The Bi-Manu-Track, enables the bilateral practice of a forearm and wrist movement, and is currently tested. For gait rehabilitation after stroke, the electromechanical gait trainer GT I has proven effective as compared to treadmill training with body weight support (BWS). The latest development is the HapticWalker, a robotic walking simulator for gait training, which allows the training of arbitrary daily life foot trajectories. The foot trajectories can be individually adjusted to each patient, in addition the machine will offer a sophisticated patient-machine-interaction. A prototype of the machine has been designed and built succesfully and is being evaluated at present. Technical possibilities are one aspect, but multi-centre trials and the consideration of unsubstantiated fears among therapists of being replaced by the machines will decide on the successful implementation of this most promising field to the benefit of patients.
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PMID:Upper and lower extremity robotic devices to promote motor recovery after stroke -recent developments. 1727 91

For individuals with a spinal cord injury or dysfunction (SCI/D), opportunities to exercise are limited and are usually not highly motivating experiences. Exercise programs or extracurricular activities may help increase or maintain the cardiovascular fitness level of individuals with SCI/D. The GAME(Wheels) system, an interface between a portable roller system and a computer, enables an individual to control a video game by propelling his or her wheelchair. The purpose of this study was to investigate whether the propulsive forces used during video play, both with and without the GAME(Wheels) system, were different. A secondary purpose was to examine differences in metabolic parameters during exercise under these two conditions. Ten manual wheelchair users exercised on the GAME(Wheels) system with and without controlling a video game. Physiological and kinetic data were collected six times during two exercise trials. Kinetic data were recorded with the SMART(Wheel) and used to investigate propulsion forces. No significant differences were found in the resultant force, rate of rise, or number of hand contacts with the pushrims. This study showed that propulsion pattern did not change significantly when wheelchair users exercised while playing a computer video game. Oxygen consumption, ventilation, and heart rate were significantly different (p < 0.05) between the two groups during the last three exercise intervals and cooldown. Playing a video game while exercising may help to motivate manual wheelchair users to exercise longer and regularly, something that was reported by this study's subjects; likewise, exercising while playing a video game may not be associated with higher pushrim forces and stroke frequencies.
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PMID:Kinetic and physiological analysis of the GAME(Wheels) system. 1794 65

We analyzed healthcare costs and medical conditions for 2,008 veterans with spinal cord injuries and disorders (SCI/Ds) near end of life. The average age at SCI/D onset and/ or occurrence was 42 years and at death was 66 years. The conditions that incurred the most costs included cancer (20.9%), influenza and/or pneumonia (15.1%), heart disease (13.5%), septicemia (5.9%), diabetes (5.3%), and stroke (5.1%). The average cost was $24,900 in the second year before end of life and reached $61,900 in the final year. Before end of life, costs accelerated during the final year from $3,100 in month 12 to $14,600 in the final month.
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PMID:Major medical conditions and VA healthcare costs near end of life for veterans with spinal cord injuries and disorders. 1900 69


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