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Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 32541

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Dr. Stéphane Mandigout

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Guest Editor

Faculty of Science and Technology, University of Limoges, 87000 Limoges, France
Interests: physical activity; exercise; aging; ecological activity; activity sensor; energy cost when walking; technological innovation; cardiovascular physiology; fatigue

Dr. Charles Sebiyo Batcho

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Guest Editor

Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
Interests: rehabilitation; technologies for rehabilitation; virtual reality; older adults; stroke
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Special Issue Information

Dear Colleagues,

Stroke is the leading cause of acquired neurological disability and a major public health concern. Post stroke rehabilitation is essential for limiting the risk of recurrence, reducing impairments and allowing the patient to maintain a good level of autonomy. For several years, we have yielded reliable results demonstrating the beneficial effects of a post-stroke care program (sub-acute or chronic). However, following a stroke, not all patients benefit from in-patient rehabilitation. Moreover, the duration of this program, usually undergone before discharge, as well as post discharge care, varies greatly depending on the country. In this Special Issue of the International Journal of Environmental Research and Public Health (IJERPH), we would like to highlight the studies that explore home care. We welcome manuscripts from different disciplines, including rehabilitation medicine, epidemiology, intervention studies, risk and health impact assessment. New research papers, reviews, case reports and brief papers that address any of the aforementioned topics are welcomed in this Special Issue, particularly those that combine a high academic standard with a practical approach to provide optimal solutions for home- or community-based stroke rehabilitation.

Dr. Stéphane Mandigout
Dr. Charles Sebiyo Batcho
Guest Editors

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Keywords

stroke
rehabilitation
home
epidemiology
health technology, health and well-being
acceptability
efficacity
physical activity
risk assessment
environment and care
health behavior

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Published Papers (10 papers)

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Research

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11 pages, 733 KiB

Open AccessArticle

Relationships between Self-Efficacy and Post-Stroke Activity Limitations, Locomotor Ability, Physical Activity, and Community Reintegration in Sub-Saharan Africa: A Cross-Sectional Study

by Aristide S. Honado, Orthelo Léonel Gbètoho Atigossou, Jean-Sébastien Roy, Jean-François Daneault and Charles Sèbiyo Batcho

Int. J. Environ. Res. Public Health 2023, 20(3), 2286; https://doi.org/10.3390/ijerph20032286 - 27 Jan 2023

Cited by 7 | Viewed by 3300

Abstract

Stroke self-efficacy is under-investigated in sub-Saharan Africa. In particular, studies focusing on the relationship between self-efficacy and post-stroke functional outcomes are scarce. This cross-sectional study aimed to explore the association between self-efficacy and post-stroke activity limitations, locomotor ability, physical activity, and community reintegration in Benin, a sub-Saharan African country. To achieve this purpose, a selection of stroke patients was made from the admission registers of the physiotherapy clinics (rehabilitation units) of three reference hospitals in Benin from January to April 2018. Stroke patients who were still continuing their rehabilitation sessions were informed by direct contact. Those who had already finished their sessions were informed by telephone. Sixty stroke patients of those contacted gave their consent and were recruited for this study. The sample consisted of 44 men and 16 women with a mean age of 56.7 ± 10.4 years. Activity limitations, locomotor ability, physical activity, community reintegration, and self-efficacy were self-reported using ACTIVLIM-Stroke, Abiloco-Benin, the Africa francophone version of the International Physical Activity Questionnaire (IPAQ-AF), the Reintegration to Normal Living Index (RNLI), and a French version of the Stroke Self-efficacy Questionnaire (SSEQ-F), respectively. Spearman’s rank correlation coefficients (ρ) were calculated to characterize the relationship between self-efficacy and activity limitations, locomotor ability, physical activity, and community reintegration. According to the results, self-efficacy showed a moderate correlation with physical activity (ρ = 0.65; p < 0.001) and high correlations with activity limitations (ρ = 0.81; p < 0.001), locomotor ability (ρ = 0.72; p < 0.001), and community reintegration (ρ = −0.84; p < 0.001). Thus, self-efficacy emerges as an important factor associated with the functional recovery of stroke patients in sub-Saharan Africa. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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14 pages, 817 KiB

Open AccessArticle

Physical Activity Level, Barriers, and Facilitators for Exercise Engagement for Chronic Community-Dwelling Stroke Survivors in Low-Income Settings: A Cross-Sectional Study in Benin

by Sènadé Inès Noukpo, Lisa Tedesco Triccas, Bruno Bonnechère, Thierry Adoukonou, Peter Feys and Oyéné Kossi

Int. J. Environ. Res. Public Health 2023, 20(3), 1784; https://doi.org/10.3390/ijerph20031784 - 18 Jan 2023

Cited by 5 | Viewed by 3076

Abstract

After a stroke incident, physical inactivity is common. People with stroke may perceive several barriers to performing physical activity (PA). This study aimed to document the PA level and understand the barriers and facilitators to engaging in PA for community-dwelling stroke survivors in Benin, a lower middle-income country. A cross-sectional study was conducted in three hospitals in Benin. Levels of PA were recorded by means of the Benin version of the International Physical Activity Questionnaire long form (IPAQ-LF-Benin), which is validated for stroke survivors in Benin. The perceived exercise facilitators and barriers were assessed by the Stroke Exercise Preference Inventory-13 (SEPI-13). A descriptive analysis and associations were performed with a Confidence Interval of 95% and <0.05 level of significance. A total of 87 participants (52 men, mean age of 53 ± 10 years, mean time after a stroke of 11 (IQR: 15) months and an average of 264.5 ± 178.9 m as distance on the 6 min walking test (6MWT) were included. Overall, stroke survivors in Benin reached a total PA of 985.5 (IQR: 2520) metabolic equivalent (METs)-minutes per week and were least active at work, domestic, and leisure domains with 0 MET-minutes per week. The overview of PA level showed that 52.9% of participants performed low PA intensity. However, 41.4% performed moderate PA or walking per day for at least five days per week. Important perceived barriers were lack of information (45.3%), hard-to-start exercise (39.5%), and travelling to places to exercise (29.9%). The preference for exercise was with family or friends, outdoors, for relaxation or enjoyment (90.2%), and receiving feedback (78.3%). Several socio-demographic, clinical, and community factors were significantly associated with moderate or intense PA (p < 0.05) in stroke survivors in this study. Our findings show that the PA level among chronic stroke survivors in Benin is overall too low relative to their walking capacity. Cultural factors in terms of the overprotection of the patients by their entourage and/or the low health literacy of populations to understand the effect of PA on their health may play a role. There is a need for new approaches that consider the individual barriers and facilitators to exercise. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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13 pages, 691 KiB

Open AccessArticle

Effects of Coaching-Based Teleoccupational Guidance for Home-Based Stroke Survivors and Their Family Caregivers: A Pilot Randomised Controlled Trial

by Li Zhang, Yan-Ning Yan, Zeng-Xin Sun, Dong-Rui Yan, Yuan-Wu Chen, Keh-Chung Lin, Xin-Jing Ge and Xiao-Lu Qin

Int. J. Environ. Res. Public Health 2022, 19(23), 16355; https://doi.org/10.3390/ijerph192316355 - 6 Dec 2022

Cited by 8 | Viewed by 2381

Abstract

The aim of this pilot study was to investigate the feasibility and effectiveness of a 3-month coaching-based teleoccupational guidance (CTG) programme for home-based stroke survivors and their family caregivers. An assessor-blind pilot randomised controlled study was conducted. Twenty-five participant dyads (each dyad consisted of one home-based stroke patient and their caregivers) were randomised to a control group (RTG, n = 12) or an experimental group (CTG, n = 13). Participant dyads in the RTG group received routine teleoccupational guidance. Participant dyads in the CTG group received a six-step procedure: coaching-based teleoccupational guidance over 3 months via WeChat. Participant dyad compliance, the difficulty and suitability of outcome measures, and adverse effects were used to assess feasibility. The Reintegration to Normal Living Index, the Lawton Instructive Activities of Daily Life (Lawton IADL) scale, the Intrinsic Motivation Inventory, the Fugl–Meyer Assessment—Upper Extremity scale, the 6 min walking test, and the Stroke-Specific Quality of Life Scale were used to assess effectiveness outcomes of home-based stroke survivors; the Caregiver Benefit Finding Scale and the Zarit Caregiver Burden Interview were used to assess the effectiveness outcomes of family caregivers. Feasibility measures were assessed at the end of the pilot trial, and effectiveness measures were evaluated pre-intervention and post-intervention (after 3 months). The CTG programme significantly improved home-based stroke survivors’ participation in daily life, IADL score, and intrinsic motivation, and increased caregivers’ perceived benefit, and tended (not significantly) to reduce care burden. CTG has the potential to promote better integration of home-based stroke patients into their families and society, improve their quality of life and family well-being, and provide a reference for home rehabilitation of other clinical chronic diseases. CTG is a safe, effective, and promising intervention for home-based stroke populations and their caregivers and warrants further investigation in a larger randomised controlled trial. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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9 pages, 475 KiB

Open AccessArticle

Effects of Compression Stockings on Body Balance in Hemiplegic Patients with Subacute Stroke

by Eo Jin Park

Int. J. Environ. Res. Public Health 2022, 19(23), 16212; https://doi.org/10.3390/ijerph192316212 - 4 Dec 2022

Viewed by 2085

Abstract

(1) Background: Stroke patients with hemiplegia have an increased risk of developing deep vein thrombosis (DVT). DVT increases the risk of life-threatening pulmonary embolism and is associated with poor prognosis. The early wearing of compression stockings can help prevent DVT. This study aimed to assess the impact of compression stockings on body balance in stroke patients with unilateral lower extremity muscle weakness; (2) Methods: Hemiplegic stroke patients in the subacute phase who were able to walk with assistance were recruited. The patients were divided into two groups: one group received rehabilitation treatment with compression stockings, and the other received treatment without compression stockings. The rehabilitation treatment involved hospitalization for 4 weeks, the Trunk Control Test (TCT), the Trunk Impairment Scale (TIS), and the Berg Balance Scale (BBS). The patients were evaluated before and 4 weeks after the start of treatment. The differences in BBS, TCT, and TIS before and after treatment between the two groups were compared; (3) Results: Altogether, 236 hemiplegic stroke patients were recruited. There was an improvement in body balance after treatment in both groups, and BBS, TCT, and TIS scores significantly increased in the group that received rehabilitation treatment with compression stockings; (4) Conclusions: In patients with hemiplegic stroke in the subacute period, rehabilitation while wearing compression stockings appears to improve body balance. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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12 pages, 790 KiB

Open AccessArticle

The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis

by Kumar Gular, Viswanathan Sivasubramanian, Ravi Shankar Reddy, Jaya Shanker Tedla and Snehil Dixit

Int. J. Environ. Res. Public Health 2022, 19(23), 15644; https://doi.org/10.3390/ijerph192315644 - 24 Nov 2022

Cited by 4 | Viewed by 1837

Abstract

Background: The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. Methods: This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk’s stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). Results: The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. Conclusions: The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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7 pages, 818 KiB

Open AccessArticle

Destruction of Vowel Space Area in Patients with Dysphagia after Stroke

by Min Kyu Choi, Seung Don Yoo and Eo Jin Park

Int. J. Environ. Res. Public Health 2022, 19(20), 13301; https://doi.org/10.3390/ijerph192013301 - 15 Oct 2022

Cited by 1 | Viewed by 1589

Abstract

Dysphagia is associated with dysarthria in stroke patients. Vowel space decreases in stroke patients with dysarthria; destruction of the vowel space is often observed. We determined the correlation of destruction of acoustic vowel space with dysphagia in stroke patients. Seventy-four individuals with dysphagia and dysarthria who had experienced stroke were enrolled. For /a/, /ae/, /i/, and /u/ vowels, we determined formant parameter (it reflects vocal tract resonance frequency as a two-dimensional coordinate point), formant centralization ratio (FCR), and quadrilateral vowel space area (VSA). Swallowing function was assessed using the videofluoroscopic dysphagia scale (VDS) during videofluoroscopic swallowing studies. Pearson’s correlation and linear regression were used to determine the correlation between VSA, FCR, and VDS. Subgroups were created based on VSA; vowel space destruction groups were compared using ANOVA and Scheffe’s test. VSA and FCR were negatively and positively correlated with VDS, respectively. Groups were separated based on mean and standard deviation of VSA. One-way ANOVA revealed significant differences in VDS, FCR, and age between the VSA groups and no significant differences in VDS between mild and moderate VSA reduction and vowel space destruction groups. VSA and FCR values correlated with swallowing function. Vowel space destruction has characteristics similar to VSA reduction at a moderate-to-severe degree and has utility as an indicator of dysphagia severity. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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12 pages, 2054 KiB

Open AccessArticle

Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial

by Min Gyun Kim, Seung Ah Lee, Eo Jin Park, Min Kyu Choi, Ji Min Kim, Min Kyun Sohn, Sung Ju Jee, Yeong Wook Kim, Jung Eun Son, Seo Jun Lee, Keum Sun Hwang and Seung Don Yoo

Int. J. Environ. Res. Public Health 2022, 19(16), 9975; https://doi.org/10.3390/ijerph19169975 - 12 Aug 2022

Cited by 5 | Viewed by 5782

Abstract

Background: Shoulder subluxation occurs in 17–64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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Review

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16 pages, 2137 KiB

Open AccessReview

Impact of Constraint-Induced Movement Therapy (CIMT) on Functional Ambulation in Stroke Patients—A Systematic Review and Meta-Analysis

by Ravi Shankar Reddy, Kumar Gular, Snehil Dixit, Praveen Kumar Kandakurti, Jaya Shanker Tedla, Ajay Prashad Gautam and Devika Rani Sangadala

Int. J. Environ. Res. Public Health 2022, 19(19), 12809; https://doi.org/10.3390/ijerph191912809 - 6 Oct 2022

Cited by 8 | Viewed by 5308

Abstract

Constraint-induced movement therapy (CIMT) has been delivered in the stroke population to improve lower-extremity functions. However, its efficacy on prime components of functional ambulation, such as gait speed, balance, and cardiovascular outcomes, is ambiguous. The present review aims to delineate the effect of various lower-extremity CIMT (LECIMT) protocols on gait speed, balance, and cardiovascular outcomes. Material and methods: The databases used to collect relevant articles were EBSCO, PubMed, PEDro, Science Direct, Scopus, MEDLINE, CINAHL, and Web of Science. For this analysis, clinical trials involving stroke populations in different stages of recovery, >18 years old, and treated with LECIMT were considered. Only ten studies were included in this review, as they fulfilled the inclusion criteria. The effect of CIMT on gait speed and balance outcomes was accomplished using a random or fixed-effect model. CIMT, when compared to controlled interventions, showed superior or similar effects. The effect of LECIMT on gait speed and balance were non-significant, with mean differences (SMDs) of 0.13 and 4.94 and at 95% confidence intervals (Cis) of (−0.18–0.44) and (−2.48–12.37), respectively. In this meta-analysis, we observed that despite the fact that several trials claimed the efficacy of LECIMT in improving lower-extremity functions, gait speed and balance did not demonstrate a significant effect size favoring LECIMT. Therefore, CIMT treatment protocols should consider the patient’s functional requirements, cardinal principles of CIMT, and cardiorespiratory parameters. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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Other

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9 pages, 679 KiB

Open AccessCase Report

A 6-Month Home-Based Functional Electrical Stimulation Program for Foot Drop in a Post-Stroke Patient: Considerations on a Time Course Analysis of Walking Performance

by Romain David, Maxime Billot, Etienne Ojardias, Bernard Parratte, Manuel Roulaud, Amine Ounajim, Frédéric Louis, Hachemi Meklat, Philippe Foucault, Christophe Lombard, Anne Jossart, Laura Mainini, Martin Lavallière, Lisa Goudman, Maarten Moens, Davy Laroche, Marjorie Salga, François Genêt, Jean-Christophe Daviet, Anaick Perrochon, Maxence Compagnat and Philippe Rigoard Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2022, 19(15), 9204; https://doi.org/10.3390/ijerph19159204 - 27 Jul 2022

Cited by 3 | Viewed by 2944

Abstract

Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, ankle foot orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional electrical stimulation (FES), consisting of stimulation of the peroneal nerve pathway, represents an alternative approach. By providing an FES device (Bioness L-300, BIONESS, Valencia, CA, USA) for 6 months to a post-stroke 22-year-old woman with a foot drop, our goal was to quantify its potential benefit on walking capacity. The gait parameters and the temporal evolution of the speed were collected with a specific connected sole device (Feet Me^®) during the 10-m walking, the time up and go, and the 6-minute walking tests with AFO, FES, or without any device (NO). As a result, the walking speed changes on 10-m were clinically significant with an increase from the baseline to 6 months in AFO (+0.14 m.s⁻¹), FES (+0.36 m.s⁻¹) and NO (+0.32 m.s⁻¹) conditions. In addition, the speed decreased at about 4-min in the 6-minute walking test in NO and AFO conditions, while the speed increased in the FES conditions at baseline and after 1, 3, and 6 months. In addition to the walking performance improvement, monitoring the gait speed in an endurance test after an ecological rehabilitation training program helps to examine the walking performance in post-stroke patients and to propose a specific rehabilitation program. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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19 pages, 1915 KiB

Open AccessSystematic Review

Measured and Perceived Effects of Upper Limb Home-Based Exergaming Interventions on Activity after Stroke: A Systematic Review and Meta-Analysis

by Axelle Gelineau, Anaick Perrochon, Louise Robin, Jean-Christophe Daviet and Stéphane Mandigout

Int. J. Environ. Res. Public Health 2022, 19(15), 9112; https://doi.org/10.3390/ijerph19159112 - 26 Jul 2022

Cited by 6 | Viewed by 2849

Abstract

After discharge from the hospital to home, stroke patients may experience weakness and reduced movement in their hemiparetic arms that limits their ability to perform daily activities. Therapists can use exercise games (exergames) to maintain functional abilities and daily use of the arm at home. A systematic review and meta-analysis was conducted to determine the efficiency of upper limb home-based rehabilitation, using exergaming on activity abilities in stroke. Randomized controlled trials were reviewed in the CENTRAL, MEDLINE, CINAHL, EMBASE, and SCOPUS online databases. Clinical measures of observation and self-reporting were studied in post-intervention and follow-up. Nine studies were included in this systematic review (535 participants). The Physiotherapy Evidence Database (PEDro) score was 6.6/10 (SD 1.0, range 5–8), indicating good quality. This systematic review and meta-analysis showed that upper limb home-based exergaming interventions were no more effective in terms of activity than conventional therapy after stroke, according to the observational and subjective assessments in post-intervention and follow-up. Using this same approach, future studies should focus on evaluating home-based exergames through subgroup analysis to be able to propose recommendations. Full article

(This article belongs to the Special Issue Rehabilitation and Physical Activity at Home in Subacute and Chronic Stroke)

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