Fysieke fitheidstraining na een cva: een review

Geen samenvatting beschikbaa

Trainen na een beroerte: dat kan! Training van de fysieke fitheid bij CVA-patiënten voor het verbeteren van de loopvaardigheid

Geen samenvatting beschikbaa

Reproducibility of Different Methodologies to Calculate Oxygen Consumption and Oxygen Cost During Walking in Chronic Stroke Survivors

Objective: The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke survivors. The objective of this study was to evaluate the 3 most commonly used methods for calculating oxygen consumption and -cost by assessing test-retest reliability and measurement error in community dwelling chronic stroke survivors during a 6 Minute Walk Test. Methods: In this secondary analysis of a longitudinal study, reproducibility of the outcome of walking distance, walking speed, oxygen consumption and oxygen cost from 3 methods (Kendall's tau, assumed steady-state and total walking time oxygen consumption) were determined using Intraclass Correlation Coefficient, Standard Error of Measurement and Smallest Detectable Change. Results: 20 from the 31 participants successfully performed the 6 minute walk test-retest within a timeframe of 1 month. Within the 2 tests the reproducibility of walking distance and walking speed was high. The 3 methods to determine reproducibility for oxygen cost and oxygen consumption were considered good (Kendall's tau), good (assumed steady-state) and excellent (total walking time). Conclusions: The method using oxygen consumption and -cost over the total walking time resulted in the highest reproducibility considering the Intraclass Correlation Coefficient, its 95% Confidence Interval, and smaller absolute differences

What’s keeping people after stroke from walking outdoors to become physically active? A qualitative study, using an integrated biomedical and behavioral theory of functioning and disability

Background: In general people after stroke do not meet the recommendations for physical activity to conduct a healthy lifestyle. Programs to stimulate walking activity to increase physical activity are based on the available insights into barriers and facilitators to physical activity after stroke. However, these programs are not entirely successful. The purpose of this study was to comprehensively explore perceived barriers and facilitators to outdoor walking using a model of integrated biomedical and behavioral theory, the Physical Activity for people with a Disability model (PAD). Methods: Included were community dwelling respondents after stroke, classified ≥ 3 at the Functional Ambulation Categories (FAC), purposively sampled regarding the use of healthcare. The data was collected triangulating in a multi-methods approach, i.e. semi-structured, structured and focus-group interviews. A primarily deductive thematic content analysis using the PAD-model in a framework-analysis’ approach was conducted after verbatim transcription. Results: 36 respondents (FAC 3–5) participated in 16 semi-structured interviews, eight structured interviews and two focus-group interviews. The data from the interviews covered all domains of the PAD model. Intention, ability and opportunity determined outdoor walking activity. Personal factors determined the intention to walk outdoors, e.g. negative social influence, resulting from restrictive caregivers in the social environment, low self-efficacy influenced by physical environment, and also negative attitude towards physical activity. Walking ability was influenced by loss of balance and reduced walking distance and by impairments of motor control, cognition and aerobic capacity as well as fatigue. Opportunities arising from household responsibilities and lively social constructs facilitated outdoor walking. Conclusion: To stimulate outdoor walking activity, it seems important to influence the intention by addressing social influence, self-efficacy and attitude towards physical activity in the development of efficient interventions. At the same time, improvement of walking ability and creation of opportunity should be considere

Group therapy task training versus individual task training during inpatient stroke rehabilitation: a randomised controlled trial

Objective: To compare the efficacy of intensive daily applied progressive group therapy task training with equally dosed individual progressive task training on self-reported mobility for patients with moderate to severe stroke during inpatient rehabilitation. Design: Randomized controlled clinical trial. Setting: In-patient rehabilitation center. Subjects: A total of 73 subacute patients with stroke who were not able to walk without physical assistance at randomisation. Interventions: Patients were allocated to group therapy task training (GT) or individual task training (IT). Both interventions were intended to improve walking competency and comprised 30 sessions of 90 minutes over six weeks. Main measures: Primary outcome was the mobility domain of the Stroke Impact Scale (SIS-3.0). Secondary outcomes were the other domains of SIS-3.0, standing balance, gait speed, walking distance, stair climbing, fatigue, anxiety and depression. Results: No adverse events were reported in either arm of the trial. There were no significant differences between groups for the SIS mobility domain at the end of the intervention (Z= −0.26, P = 0.79). No significant differences between groups were found in gait speed improvements (GT:0.38 ±0.23; IT:0.26±0.35), any other gait related parameters, or in non-physical outcomes such as depression and fatigue. Conclusion: Inpatient group therapy task training for patients with moderate to severe stroke is safe and equally effective as a dose-matched individual task training therapy. Group therapy task training may be delivered as an alternative to individual therapy or as valuable adjunct to increase time spent in gait-related activities

Feasibility, reproducibility and validity of the 10 meter Shuttle Test in mild to moderately impaired people with stroke.

BackgroundThere currently is no field test available for measuring maximal exercise capacity in people with stroke.ObjectiveTo determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke.DesignLongitudinal study design.SettingRehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation.SubjectsPeople with subacute or chronic stroke.InterventionsA standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST).Main measuresNumber of shuttles completed, 1stVentilatory Threshold (1stVT).ResultsThe associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001).ConclusionsThe Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s

The role of postural control in the association between aerobic capacity and walking capacity in chronic stroke: a cross-sectional analysis

BACKGROUND: Reports on the association between aerobic capacity and walking capacity in people after stroke show disparate results. AIM: The aim of this study was to determine: 1) if the predictive validity of peak oxygen uptake (VO2peak) for walking capacity post stroke is different from that of maximal oxygen uptake (VO2max), and 2) if postural control, hemiplegic lower extremity muscle strength, age and gender distort the association between aerobic capacity and walking capacity. DESIGN: Cross-sectional study. SETTING: General community in Utrecht, The Netherlands. POPULATION: Community-dwelling people more than three months after stroke. METHODS: Measurement of aerobic capacity were performed with cardiopulmonary exercise testing (CPET) and differentiated between the achievement of VO2peak or VO2max. Measurement of walking capacity with the 6-Minute Walk Test (6MWT), postural control with the Performance-Oriented Mobility Assessment (POMA) and hemiplegic lower extremity muscle strength with the Motricity Index (MI-LE). RESULTS: Fifty-one out of 62 eligible participants, aged 64.7±12.5 years were included. Analysis of covariance (ANCOVA) showed a non-significant difference between the predictive validities of VO2max (N.=22, β=0.56; 95% CI: 0.12-0.97) and VO2peak (N.=29, β=0.72; 95% CI: 0.38-0.92). Multiple regression analysis of the pooled sample showed a significant decrease in the β value of VO2peak (21.6%) for the 6MWT when adding the POMA as a covariate in the association model. VO2peak remained significantly related to 6MWT after correcting for the POMA (β=0.56, 95% CI: 0.39-0.75). CONCLUSIONS: The results suggest similar predictive validity of aerobic capacity for walking capacity in participants achieving VO2max compared to those only achieving VO2peak. Postural control confounds the association between aerobic capacity and walking capacity. Aerobic capacity remains a valid predictor of walking capacity. CLINICAL REHABILITATION IMPACT: Aerobic capacity is an important factor associated with walking capacity after stroke. However, to understand this relationship, postural control needs to be measured. Both aerobic capacity and postural control may need to be addressed during interventions aiming to improve walking capacity after stroke

Tape of brace na een inversietrauma bij sporters: criteria voor de keuze

Geen samenvatting beschikbaa

Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study

Objective: To investigate the feasibility and the effects on gait of a high intensity task-oriented training, incorporating a high cardiovascular workload and large number of repetitions, in patients with subacute stroke, when compared to a low intensity physiotherapy-programme. Design and subjects: Randomized controlled clinical trial: Forty-four patients with stroke were recruited at 2 to 8 weeks after stroke onset. Measures: Maximal gait speed assessed with the 10-metre timed walking test (10MTWT), walking capacity assessed with the six-minute walk test (6MWT). Control of standing balance assessed with the Berg Balance Scale and the Functional Reach test. Group differences were analysed using a Mann-Whitney U-test. Results: Between-group analysis showed a statistically significant difference in favour of the high intensity task-oriented training in performance on the 10MTWT (Z = -2.13, P = 0.03) and the 6MWT (Z = -2.26, P = 0.02). No between-group difference were found for the Berg Balance Scale (Z = -0.07, P = 0.45) and the Functional Reach test (Z = -0.21, P = 0.84). Conclusion: A high-intensity task-oriented training programme designed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy- programme in terms of gait speed and walking capacity in patients with subacute stroke. In a future study, it seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking. © 2010 The Author(s)