Training locomotor pattern generating networks (CPGs) with body weight supported treadmill training or through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5-weeks of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1Hz arm cycling. Clinical function tests assessed walking, balance and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion and muscle activation. ‘Normalization’ of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflexes amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma. / Graduate

Bakgrund:Stroke är den vanligaste orsaken till neurologisk funktionsnedsättning i Sverige. Tiden efter insjuknandet i stroke delas in i tre återhämtningsfaser och patienter kan uppleva förbättringar under alla tre faser. Bålfunktion är grundläggande för gångförmåga och balans varför bålträning är en av flera fysioterapeutiska behandlingsmetoder vid rehabilitering av stroke. Viss tillförlitlighet finns avseende effekt av bålträning vid akut och subakut fas av stroke men den är oklar vid kronisk fas av stroke. Kunskapsläget behöver därför granskas och sammanställas.  Syfte: Att undersöka effekten av bålträning på gånghastighet och balans vid kronisk stroke.  Metod:Studiens design var en systematisk översikt där randomiserade kontrollerade studier inkluderades. Systematiska sökningar utfördes i databaserna PubMed, CINAHL och Web of Science samt kompletterande sökning i referenslista i Cochrane protokoll. Bedömning av artiklarnas kvalitet genomfördes enligt PEDro skalan och den sammanvägda tillförlitligheten granskades med modifierad förenklad GRADE. Resultat:Urvalsprocessen genererade tio artiklar, varav en artikel med låg kvalitet exkluderades från vidare granskning. En artikel bedömdes ha måttlig kvalitet och åtta artiklar bedömdes ha hög kvalitet enligt PEDro. Resultatet av granskningen visade på motstridiga resultat gällande effekter av bålträning på balans och gånghastighet samt en låg tillförlitlighet i den sammanvägda bedömningen. Konklusion:Utifrån denna systematiska översikt är det inte möjligt att fastställa bålträningens effekt på gånghastighet eller balans vid kronisk stroke. Översikten visar på motstridiga resultat samt låg tillförlitlighet i den sammanvägda bedömningen. Ytterligare forskning behövs för att fastställa bålträningens effekt på gånghastighet och balans vid kronisk stroke. / Background: Stroke is the most common cause of neurological disability in Sweden. Stroke is divided into different phases and improvements can occur several years after debut. Trunk function is fundamental for gait ability and balance, which is why trunk training is one of several physical therapy methods. Regarding the chronic phase of stroke, there is a need to compile state of evidence for trunk training. Purpose: To investigate the effect of trunk training on gait speed and balance in chronic stroke. Method: Literature review with randomized controlled trials included. Systematic searches were made in the databases PubMed, CINAHL and Web of Science and in the reference list of a Cochrane protocol. Quality assessment of the articles was done with PEDro and the combined reliability was examined with Modifierad förenklad GRADE. Results: The selection process generated ten articles, of which one low-quality article was excluded. one article were of moderate quality and eight of high quality. The results of the review showed conflicting results regarding the effects of trunk training on balance and walking speed, as well as a low reliability in the combined assessment.  Conclusion: Based on this systematic review, it is not possible to determine the effect of trunk training on walking speed or balance in chronic stroke. The overview shows conflicting results and low reliability in the combined assessment. Further research should determine the effect of trunk training on gait speed and balance in chronic stroke.

Background and Purpose: Dance has demonstrated beneficial effects on mobility in older individuals with movement disorders; yet, effects of partnered dance remain unexamined in individuals with chronic stroke. The purpose of this study was to describe the effects of adapted tango classes on balance, mobility, gait, endurance, dual-task ability, quality of life (QOL), and enjoyment in an older individual with chronic stroke and visual impairment. Case Description: D.L. was a 73-year-old African American man, 13 years poststroke with spastic hemiplegia, visual impairment, and multiple comorbidities. Intervention: D.L. attended 20 1?-hour tango classes adapted for older individuals with sensory and motor impairments over 11 weeks. Outcomes: Measures of balance, mobility, gait, endurance, dual-task ability, and QOL were evaluated before and after the intervention and at 1-month follow-up. D.L. improved on the Berg Balance Scale, 30-s chair stand, Timed Up and Go (single, manual, and cognitive conditions), 6-Minute Walk Test, and backward gait speed. Not all measures improved: balance confidence decreased, and there was no change in forward and fast gait speed or QOL, as measured by the Short Form-12 and the Visual Function Questionnaire–25. Some gains were maintained at one-month follow-up. D.L. reported enjoying the classes, noted improvement in physical well-being, and wanted to continue the program. Discussion: Thirty hours of adapted tango lessons improved balance, mobility, endurance, and dual-task ability in a participant with chronic stroke. The participant enjoyed the classes, was adherent, and wished to continue. This is the first reported use of adapted tango dance as rehabilitation for an individual with chronic stroke and low vision.

No description available.

The roles of the vascular architecture and blood flow in response to neurovascular diseases are important in predicting physiological outcomes. Observing these parameters chronically with optical imaging techniques provides insight into the neurovascular recovery process. We develop and deploy optical imaging systems for monitoring the progression of vascular structure, perfusion, and functional blood response after ischemic stroke in a chronic rodent model to observe vascular dynamics of the cortex under normal and diseased pathologies. Specifically, we monitor the progression of the vascular structure and cerebral blood flow (CBF) over a chronic period in the rodent cortex after photo-thrombotic occlusion. Multi-Exposure Speckle Imaging (MESI) provides surface measurements of microvascular flow dynamics while Two-Photon Fluorescence Microscopy offers direct visualization of the microvascular structure. We observe the occurrence of vascular reorientation in the sub-surface microvascular structure over a 35 day post-occlusion period. We also correlate MESI flow estimates in the parenchyma with sub-surface microvascular volume fractions from two-photon microscopy to assess how vascular density influences the surface-integrated MESI measurements. Next, we develop and validate a MESI technique for measuring absolute changes of the functional blood flow response to forepaw stimulation in rodents, termed FA MESI. The optimal camera exposures for capturing the CBF response to forepaw stimulation are extracted from a training set of animal data and the feasibility of the technique is demonstrated in a testing animal set by comparing functional response results between new and existing techniques. We then deploy this system in a chronic study monitoring the progression of hemodynamic parameters after ischemic stroke within the functionally responding area of the cortex. The progression of the regional CBF perfusion and absolute changes in the magnitude of the functional blood flow response are monitored chronically after photo-thrombotic occlusion. We compare the differences between absolute and relative measurements of the functional blood flow responses, and validate FA MESI by comparing baseline measurements to 15-exposure MESI over the sampled flow distributions. We demonstrate the differences measured between the functional outcomes and the regional CBF perfusion over a three week post-occlusion time period. / text