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Ryoji Kiyama, Kiyohiro Fukudome, Toshiki Hiyoshi, Akihide Umemoto, Yoichi Yoshimoto, and Tetsuo Maeda

The aim of this study was to examine the dexterity of both lower extremities in patients with stroke. Twenty patients with stroke and 20 age-matched control subjects participated in this study. To determine the dexterity of the lower extremities, we examined the ability to control muscle force during submaximal contractions in the knee extensor muscles using a force tracking task. The root mean square errors were calculated from the difference between the target and response force. The root mean square error was significantly greater in the affected limb of patients with stroke compared with those of the unaffected limb and the control subjects, and in the unaffected limb compared with that of the control subjects. Furthermore, the root mean square error of the affected limb was related significantly to motor function as determined by Fugl-Myer assessment. These results demonstrate impairment of the dexterity of both the affected and the unaffected lower extremities in patients with stroke.

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Joni S. Yates, Stephanie Studenski, Steven Gollub, Robert Whitman, Subashan Perera, Sue Min Lai, and Pamela W. Duncan

This study evaluated the feasibility, safety, and findings from a protocol for exercise-bicycle ergometry in subacute-stroke survivors. Of 117 eligible candidates, 14 could not perform the test and 3 discontinued because of cardiac safety criteria. In the 100 completed tests, peak heart rate was 116 ± 19.1 beats/min; peak VO2 was 11.4 ± 3.7 ml · kg · min−1, peak METs were 3.3 ± 0.91, exercise duration was 5.1 ± 2.84 min., and Borg score was 14 ± 2.6. Among 71 tests, anaerobic threshold was achieved in 3.0 ± 1.7 min with a VO2 of 8.6 ± 1.7 ml · kg · min−1. After screening, this protocol is feasible and safe in subacute-stroke survivors with mild to moderate deficits. These stroke survivors have severely limited functional exercise capacity. Research and clinical practice in stroke rehabilitation should incorporate more comprehensive evaluation and treatment of endurance limitations.

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Debra G. George-Reichley and Jill S. Higginson

The understanding of individual muscle impairments that affect swing phase in stroke gait will lead to better rehabilitation strategies for this population. We used induced acceleration analysis to evaluate the potential each muscle has to accelerate the hip and knee joints of the swing limb, using kinematics from three stroke subjects and five healthy subjects. To determine the influence of altered limb position on muscle function, we augmented hip extension by 10° in swing phase for all subjects. We found that in early swing, healthy subjects had greater potential to accelerate the knee into flexion than stroke subjects, whereas stroke subjects had greater potential to accelerate the hip into flexion. Perturbing the hip flexion angle into greater extension increased the potential of biarticular muscles to flex the knee in swing phase. The potential of muscles to improve swing phase dynamics depends on the initial posture of the limb and highlights the importance of subject-specific evaluations in the design of appropriate therapeutic interventions.

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Michael D. Lewek, Claire E. Bradley, Clinton J. Wutzke, and Steven M. Zinder

Falls are common after stroke and often attributed to poor balance. Falls often occur during walking, suggesting that walking patterns may induce a loss of balance. Gait after stroke is frequently spatiotemporally asymmetric, which may decrease balance. The purpose of this study is to determine the relationship between spatiotemporal gait asymmetry and balance control. Thirty-nine individuals with chronic stroke walked at comfortable and fast speeds to calculate asymmetry ratios for step length, stance time, and swing time. Balance measures included the Berg Balance Scale, step width during gait, and the weight distribution between legs during standing. Correlational analyses determined the relationships between balance and gait asymmetry. At comfortable and fast gait speeds, step width was correlated with stance time and swing time asymmetries (r = 0.39−0.54). Berg scores were correlated with step length and swing time asymmetries (r = –0.36 to –0.63). During fast walking, the weight distribution between limbs was correlated with stance time asymmetry (r = –0.41). Spatiotemporal gait asymmetry was more closely related to balance measures involving dynamic tasks than static tasks, suggesting that gait asymmetry may be related to the high number of falls poststroke. Further study to determine if rehabilitation that improves gait asymmetry has a similar influence on balance is warranted.

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Geetanjali Gera, Kelsey E. McGlade, Darcy S. Reisman, and John Peter Scholz

In this study, we investigated deficits in coordination of trunk muscle modes involved in the stabilization of the trunk’s trajectory for reaching upward and downward beyond functional arm length. Trunk muscle activity from 10 stroke survivors (8 men, 2 women; 64.1 ± 10.5 years old) and 9 healthy control subjects (7 men, 2 women; 59.3 ± 9.3 years old) was analyzed. Coordination of trunk muscle modes to stabilize the trunk trajectory was investigated using the uncontrolled manifold (UCM) analysis. The UCM analysis decomposes the variability of muscle modes into good and bad variability. The good variability does not affect the control of trunk motion, whereas the bad variability does. In stroke survivors, deficits in the ability to flexibly combine trunk muscle modes was associated with reduced ability to minimize those combinations of trunk muscle modes that led to an error in trunk trajectory (bad variability), and this had a greater effect on reaching upward. This reduced coordination of trunk muscle modes during reaching was correlated with a clinical measure of trunk impairment.

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Astrid C.J. Balemans, Han Houdijk, Gilbert R. Koelewijn, Marjolein Piek, Frank Tubbing, Anne Visser-Meily, and Olaf Verschuren

only a lack of physical activity but also a lack of SB for prolonged periods of time contributes to a higher risk of early, all-cause, and cardiovascular mortality. 9 , 10 Persons with long-term neurological disorders, such as stroke and cerebral palsy (CP), are predisposed to high levels of sedentary

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André G. P. Andrade, Janaine C. Polese, Leopoldo A. Paolucci, Hans-Joachim K. Menzel, and Luci F. Teixeira-Salmela

Lower extremity kinetic data during walking of 12 people with chronic poststroke were reanalyzed, using functional analysis of variance (FANOVA). To perform the FANOVA, the whole curve is represented by a mathematical function, which spans the whole gait cycle and avoids the need to identify isolated points, as required for traditional parametric analyses of variance (ANOVA). The power variables at the ankle, knee, and hip joints, in the sagittal plane, were compared between two conditions: With and without walking sticks at comfortable and fast speeds. For the ankle joint, FANOVA demonstrated increases in plantar flexion power generation during 60–80% of the gait cycle between fast and comfortable speeds with the use of walking sticks. For the knee joint, the use of walking sticks resulted in increases in the knee extension power generation during 10–30% of the gait cycle. During both speeds, the use of walking sticks resulted in increased power generation by the hip extensors and flexors during 10–30% and 40–70% of the gait cycle, respectively. These findings demonstrated the benefits of applying the FANOVA approach to improve the knowledge regarding the effects of walking sticks on gait biomechanics and encourage its use within other clinical contexts.

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Brice T. Cleland and Sheila Schindler-Ivens

There are many examples of altered movement-related brain activation in individuals with poststroke hemiparesis. Changes in the extent, intensity, and location of brain activation have been observed during upper and lower limb movements, in acute and chronic stroke survivors, and before and after

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Etem Curuk, Yunju Lee, and Alexander S. Aruin

 al., 2010a , 2010b ). Individuals with stroke frequently demonstrate asymmetry of stance with impaired balance control ( Aruin, Hanke, Chaudhuri, Harvey, & Rao, 2000 ; Chaudhuri & Aruin, 2000 ). Several researchers suggested that the inability to coordinate the activation of postural muscles with focal

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Margaret C. Morrissey, Michael R. Szymanski, Andrew J. Grundstein, and Douglas J. Casa

Exertional heat stroke (EHS) is a life-threatening condition characterized by an internal temperature ≥40°C with central-nervous-system dysfunction ( Casa et al., 2015 ). EHS is interesting to study when examining prevention strategies and factors that predispose individuals to develop the