Objective: To investigate the feasibility and efficacy of a task-specific homebased exercise protocol for improving sit-to-stand (STS), with additional exercises to strengthen lower limb extensor muscles in patients with chronic stroke.
Design: A pre-test, post-test design was used.
Subjects: Six subjects at least one year post stroke and discharged from all rehabilitation services for at least six months participated in the study.
Outcome measures: Functional performance of sit-to-stand was evaluated using the Standing Up item of the Motor Assessment Scale (MAS). Peak vertical ground reaction force, walking speed over 10 m and grip strength were also measured.
Results: Group MAS score was significantly higher at post-test than at pretest with two subjects reaching the highest point on the scale and three subjects reaching the second highest point. Time-to-peak vertical ground reaction force occurred significantly closer to thighs-off, the critical time when the body mass is propelled into standing. Walking speed increased significantly over 10 m from a mean of 0.86 m/s to 1.10 m/s. Grip strength, which was not trained, did not change.
Conclusions: This study demonstrates that a home-based task-specific exercise and training protocol for STS can induce improved performance of STS and increase walking speed more than one year after stroke.
References
1.
Corr S, Bayer A. Poor functional status of stroke patients after hospital discharge. Br J Occup Ther1992; 55: 383–385.
2.
Duncan P. Stroke disability. Phys Ther1994; 74: 399–407.
3.
Bergquist TF, Jacket MP. Awareness and goal setting with the traumatically brain injured. Brain Injury1993; 7: 273–282.
4.
Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke. Arch Phys Med Rehabil2000; 81: 409–417.
Shepherd RB, Gentile AM. Sit-to-stand: functional relationships between upper body and lower limb segments. Hum Movement Sci1994; 13: 817–840.
7.
Shepherd RB, Koh HP. Some biomechanical consequences of varying foot placement in sit-to-stand in young women. Scand J Rehabil Med1996; 28: 79–88.
8.
Rutherford OM. Muscular coordination and strength training. Implications for injury rehabilitation. Sports Med1988; 5: 196–202.
9.
Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther1985; 65: 175–180.
10.
Ada L, Westwood P. A kinematic analysis of recovery of the ability to stand up following stroke. Aust J Physiother1992; 38: 135–142.
11.
Ada L, O’Dwyer NJ, Neilson PD. Improvement in kinematic characteristics and coordination following stroke quantified by linear systems analysis. Hum Movement Sci1992; 12: 137–153.
12.
Magill RA. Motor learning concepts and applications. New York: McGraw-Hill, 1998.
13.
Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: effects on function and spasticity. Arch Phys Med Rehabil1997; 78: 1231–1236.
14.
Nugent JA, Schurr KA, Adams RA. A doseresponse relationship between amount of weightbearing exercise and walking outcomes following cerebrovascular accident. Arch Phys Med Rehabil1994; 75: 399–402.
15.
Sherrington C, Lord SR. Home exercise to improve strength and walking velocity after hip fracture: A randomised controlled trial. Arch Phys Med Rehabil1997; 78: 208–212.
16.
Biddle S, Mutrie N. Psychology of physical activity and exercise. London: Springer-Verlag, 1991.
17.
Wade DT, Wood VA, Hewer RL. Recovery after stroke: The first 3 months. J Neurol Neurosurg Psychiatry1985; 48: 7–13.
18.
Duncan PW, Goldstein LB, Matchar D, Divine GW, Feussner J. Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke1992; 23: 1084–1089.
19.
Dean CM, Shepherd RB. Task-related training improves performance of seated reaching tasks following stroke: a randomised controlled trial. Stroke1997; 28: 722–728.
20.
Teixeira-Salmela LF, Olney SJ, Nadeau S, Brouwer B. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil1999; 80: 1211–1218.
