Cerebral vascular disease is one of the main causes of morbidity, disability and mortality in developed countries. Problems with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke and addresses impairments related to movement and posture in order to improve motor recovery and restore function. Purpose: to investigate the relationship between knee muscle strength, balance and functional
independence within the first month after stroke

Batista, F.

Beckert, P.

Evangelista, I.

Fernandes, Beatriz

Ferreira, M. J.

Prates, L.

Sérgio, J. Silveira

Physiotherapy

Purpose: to investigate the relationship between knee muscle strength, balance and functional independence within the first month after stroke. Relevance: cerebral vascular disease is one of the main causes of morbidity, disability and mortality in developed countries. Problems with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the
risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke and addresses impairments related to movement and posture in order to improve motor recovery and restore function

Repositório Científico do Instituto Politécnico de Lisboa

Research Report Poster Display   Number: RR-PO-208-16-Tue Tuesday 21 June 2011 12:00Physiotherapy Volume 97 Supplement S1 RAI: Exhibit Halls 2 & 3  KNEE MUSCLE STRENGTH, BALANCE AND FUNCTIONAL INDEPENDENCE IN PERSONS WITH STROKE  Fernandes B.1, Batista F.2, Beckert P.3, Evangelista I.2, Ferreira M.J.2, Prates L.3, Silveira Sérgio J.4  1Lisbon Polytechnic Higher School of Health Technology, Physiotherapy, Lisboa, Portugal, 2Hospital Fernando Fonseca, Physiotherapy, Amadora, Portugal, 3Hospital Fernando Fonseca, Physical Medicine and Rehabilitation, Amadora, Portugal, 4Lisbon Polytechnic Higher School of Health Technology, Medical Sciences, Lisboa, Portugal  Purpose: To investigate the relationship between knee muscle strength, balance and functional independence within the first month after stroke.  Relevance: Cerebral vascular disease is one of the main causes of morbidity, disability and mortality in developed countries. Problems with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke and addresses impairments related to movement and posture in order to improve motor recovery and restore function.  Participants: Subjects were recruited at Physiotherapy Department of Hospital Fernando Fonseca within the first month after stroke. We studied 8 patients, all males, mean age 62,5±6,2y, with unilateral stroke (7 ischemic, 1 hemorrhagic), in the middle cerebral artery territory, who were admitted to physiotherapy department. All subjects have no cognitive impairment according to Mini Mental State, no history of lower limb orthopedic problems and no other disease that could interfere with physiotherapy treatments. All subjects gave their informed consent to participate in this investigation.  Methods: A test protocol was set up. Knee muscle strength (extensors and flexors) was measured on an isokinetic dynamometer. Balance and functional independence were assessed using the Berg Balance Scale (BBS) and the Modified Barthel Index (MBI) respectively.  Analysis: The results were analyzed in an SPSS program version 17.0. Descriptive statistics were used to characterize the participants. A correlation analysis was performed using knee muscle strength, BBS and MBI. The significance level was set at p < 0,05.  Results: Knee extensors from the affected lower limb show a deficit of 26,6% regarding knee extensors from the opposite knee. For knee flexors the deficit is 34,5%. Mean score for BBS is 29,63 ± 14,81 in a 56 point scale which indicates risk of fall. MBI mean score of 65,63 ± 17,33 indicates functional dependence. The correlation analysis demonstrates a positive correlation between BBS and MBI (Spearman correlation coefficient is 0,898 with p value = 0,002 < 0,01. These results indicate that function increase with balance.  Conclusions: After stroke knee strength from the affected lower limb is impaired. It appears to be important to improve knee muscle strength from the affected lower limb to reduce weakness. In addition persons with stroke have higher risk of falls and are functionally dependent. There is evidence that balance is an important feature for functional independence in persons with stroke. Further research is needed to investigate the effect of knee muscle strength training on balance and function.  Implications: These results indicate that early physiotherapy is needed after stroke. Intervention must focus on strength and balance training in order to improve stability and help persons with stroke to become functionally independent .  Key-words: 1. Stroke 2. Balance 3. Functional independence Funding acknowledgements: Supported by Portuguese Foundation for Science and Technology Grant SFRH/PROTEC/49675/2009.  Ethics approval: Approved by the ethics committee of Fernando Fonseca Hospital, Amadora, Portugal.   Session name: NEUROLOGY: Stroke 1  Programme track/theme: Professional Practice - NEUROLOGY: Stroke   All authors, affiliations and abstracts have been published as submitted. Published in partnership with Elsevier publishers and the Physiotherapy journal.       

Knee muscle strength, balance and functional independence in persons with stroke

ResultsIntroductionCerebral vascular disease is one of the main causes of morbidity,disability and mortality in developed countries. Problems with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke and addresses impairments related to movement and posture in order to improve motor recovery and restore function.PurposeTo investigate the relationship between knee muscle strength, balance and functionalindependence within the first month after stroke.ParticipantsSubjects were recruited at Physiotherapy Department of Hospital Fernando Fonseca within the first month after stroke. N=8 (all male)Mean age 62,5±6,2y, with unilateral stroke (7 ischemic, 1 hemorrhagic) middle cerebral artery territoryTime since stroke: 15±7 daysInclusion criteriaSingle unilateral stroke in the middle cerebral artery territoryNo cognitive impairment according to MiniMental StateNo cardiac complications  No lower limb orthopedic problemsNo other diseases that could interfere with balanceInform consent to participate in the studyMethodsThe test protocol includes assessment of strength, balance and functionality. Knee muscle strength (extensors and flexors) was measured on the isokinetic dynamometer. Cybex 6000®.Balance was assessed with the Berg Balance Scale (BBS) Functional independence was assessed with the Modified Barthel Index (MBI).The results were analyzed at the SPSS program version 17.0. Descriptive statistics were used to characterize the participants. A correlation analysis was performed using knee muscle strength, BBS and MBI. The significance level was set at p < 0,05.MUSCLE STRENGTH, BALANCE AND FUNCTIONAL INDEPENDENCEIN PERSONS WITH STROKE Fernandes, B.1, Batista, F.2, Beckert, P.2, Evangelista, I.2, Ferreira, M.J.2, Prates, L.2, Silveira Sérgio, J.11 Lisbon Polytechnic Higher School of Health Technology, Lisboa, Portugal, 2 Hospital Fernando Fonseca, Amadora, Portugal, Descriptive StatisticsN Minimum Maximum MeanStd. DeviationMBI 8 33 80 65,63 17,328BBS 8 6 44 29,63 14,813FAS 8 28 75 47,63 17,856FNAS 8 60 103 76,00 15,510EAS 8 43 119 87,13 22,592ENAS 8 65 134 113,25 20,810Valid N 8Ratio Statistics for Flexors affected side / non affected side Price Related Differential 1,024Coefficient of Dispersion ,269Coefficient ofVariation34,5%Ratio Statistics for Extensors affected side / non affected side  Price Related Differential 1,024Coefficient of Dispersion ,172Coefficient ofVariation26,6%MBI – MODIFIED BARTHEL INDEXBBS – BERG BALANCE SCALEFAS – FLEXORS AFFECTED SIDEFNAS – FLEXORS NON AFFECTED SIDEEAS – EXTENSORS AFFECTED SIDEENAS – EXTENSORS NON AFFECTED SIDEThe scatterplot shows that as BBS score increases, MBI score also increases, which indicates a positive correlation between the two variables. Spearman correlation coefficient= 0,898, N =8, p=0,002 < 0,01Discussion & ConclusionsAfter stroke knee strength from the affected lower limb is impaired. It appears to be important to improve knee muscle strength from the affected lower limb to reduce weakness. In addition persons with stroke have higher risk of falls and are functionally dependent. There is evidencethat balance is an important feature for functional independence in persons with stroke.RecommendationsFurther research is needed to investigate the effect of knee muscle strength training on balance and function.These results indicate that early physiotherapy is needed after stroke. Intervention must focus on strength and balance training in order to improve stability and help persons with stroke to become functionally independent .ReferencesAndersson A. et al (2006). How to identify potential fallers in a stroke unit: validity indexes of four tests methods. Journal of Rehabilitation Medicine, 38, pp 186-191 Carr, J. & Shepherd, R. (2003). Stroke rehabilitation: guidelines for exercise and training to optimize motor skill. Butterworth Heinemann Czernuszenko A & Czlonkowska A (2008). Risk factors for falls in stroke patients during inpatient rehabilitation. Clinical Rehabilitation, 23, pp 176-188Lennon S (2004). The theoretical basis of neurological physiotherapy. In Physical management in neurological rehabilitation. 2nded. M. Stokes, (Ed). London: Elsevier MosbyPollock A, Baer G, Pomeroy V, Langhorne P (2005). Physiotherapy treatment for the recovery of postural control and lower limb function following stroke. Cochrane review. The Cochrane Collaboration. John Wiley & Sons. Shumway-Cook A & Woollacott M (2007). Motor control: translating research into clinical practice.  3rd ed. Philadelphia: Lippincott Williams & Wilkins.AcknowledgementsApproved by the Ethics Committee of Fernando Fonseca HospitalSupported byPresented at World Physical Therapy 2011, Amsterdam, June 2011Contact detailsBeatriz Fernandesbeatriz.fernandes@estesl.ipl.ptKnee extensors from the affected lower limb show a deficit of 26,6% regarding knee extensors from non affected lower limbKnee flexors from the affected lower limb show a deficit  of 34,5% regarding knee flexors  from non affected lower limb

Muscle strength, balance and functional independence in persons with stroke

Purpose: To investigate the relationship between knee muscle strength, balance and functional independence within the first month after stroke.
Relevance: Cerebral vascular disease is one of the main causes of morbidity, disability and mortality in developed countries. Problems
with movement control are frequent after stroke. Lower limb weakness and impaired balance are common problems that are related with the
risk of falls and are likely to interfere with the ability to perform daily life activities. Physiotherapy intervention usually starts early after stroke
and addresses impairments related to movement and posture in order to improve motor recovery and restore function.
Participants: Subjects were recruited at Physiotherapy Department of Hospital Fernando Fonseca within the first month after stroke.
We studied 8 patients, all males, mean age 62,5±6,2y, with unilateral stroke (7 ischemic, 1 hemorrhagic), in the middle cerebral artery
territory, who were admitted to physiotherapy department. All subjects have no cognitive impairment according to Mini Mental State, no history
of lower limb orthopedic problems and no other disease that could interfere with physiotherapy treatments. All subjects gave their
informed consent to participate in this investigation.
Methods: A test protocol was set up. Knee muscle strength (extensors and flexors) was measured on an isokinetic dynamometer. Balance
and functional independence were assessed using the Berg Balance Scale (BBS) and the Modified Barthel Index (MBI) respectively.
Analysis: The results were analyzed in an SPSS program version 17.0. Descriptive statistics were used to characterize the participants.
A correlation analysis was performed using knee muscle strength, BBS and MBI. The significance level was set at p < 0,05.
Results: Knee extensors from the affected lower limb show a deficit of 26,6% regarding knee extensors from the opposite knee. For knee
flexors the deficit is 34,5%. Mean score for BBS is 29,63 ± 14,81 in a 56 point scale which indicates risk of fall. MBI mean score of 65,63 ±
17,33 indicates functional dependence. The correlation analysis demonstrates a positive correlation between BBS and MBI (Spearman
correlation coefficient is 0,898 with p value = 0,002 < 0,01. These results indicate that function increase with balance.
Conclusions: After stroke knee strength from the affected lower limb is impaired. It appears to be important to improve knee muscle
strength from the affected lower limb to reduce weakness. In addition persons with stroke have higher risk of falls and are functionally
dependent. There is evidence that balance is an important feature for functional independence in persons with stroke. Further research is
needed to investigate the effect of knee muscle strength training on balance and function.
Implications: These results indicate that early physiotherapy is needed after stroke. Intervention must focus on strength and balance training
in order to improve stability and help persons with stroke to become functionally independent 

Fernandes, B

Batista, F

Beckert, P

Ivangelista, I

Ferreira, MJ

Prates, L

Sérgio, J

Repositório do Hospital Prof. Doutor Fernando Fonseca

http://repositorio.ipl.pt/bitstream/10400.21/487/1/Muscle%20strength%2c%20balance%20and%20functional%20independence%20in%20persons%20with%20stroke.pdf

Muscle strength, balance and functional independence in persons with stroke

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