The purpose of this study is to elucidate pathophysiological mechanisms behind gait disturbances during the early recovery phase after hemiparetic stroke to identify targets for new treatment strategies. Using an explorative, observational study design, pathophysiological mechanisms at play during the early recovery phase will be monitored, by repeated clinical assessments during inpatient rehabilitation as well as examinations of muscle activation patterns, kinematics of walking, corticospinal and reticulospinal function \< 1 month, 3 and 6 months after hemiparetic stroke. Inclusion: Eligible patients will have suffered a stroke, verified by CT or MRI examination and are admitted to inpatient care at the University Department of Rehabilitation Medicine Danderyd Hospital (RUDS). Thirty patients will be included consecutively. With an anticipated loss of 4-10 patients, at least 20 are expected to complete the study. The clinical assessment protocols include standardized measures for the assessment of clinical and self-perceived aspects of functioning and disability. These assessments will be performed and repeated \< 1 month, at 3 months and 6 months post-stroke by a therapist not responsible for rehabilitation interventions. At each of these assessment instances, laboratory movement analysis including electromyography (EMG) and ultrasound of the lower extremity muscle will be performed. In addition, a short assessment of body function and activity will be performed weekly during inpatient rehabilitation.
Study Type
OBSERVATIONAL
Enrollment
6
Laboratory movement analysis, navigated transcranial magnetic stimulation and clinical aspects of gait function and walking.
Department of Rehabilitation Medicine, Danderyd Hospital
Danderyd, Stockholm County, Sweden
Fugl-Meyer score (FMA-LE)
Assesses sensory and movement related functions in the lower extremity (0p max impairment summed up to 86p max no detected impairment)
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Motion analysis during gait
In a movement laboratory (Vicon V16), data for motion analysis will be collected by assessing orientation of body segments and joint angle trajectories and forces by means of force plates (AMTI) during walking.
Time frame: At baseline, at 3 and 6 months to assess change.
Electromyography (EMG)
EMG is used to measure muscle activation patterns during gait.
Time frame: At baseline, at 3 and 6 months to assess change.
Neuroflexor
Medical technology device. Assesses spasticity by identifying the neural, viscous and elastic components during passive movement using a biomechanical algorithm (presented in Newton)
Time frame: At baseline, at 3 and 6 months to assess change.
Modified Ashworth scale 0-5
Assesses spasticity on a 6 point scale/muscle (0p no impairment, 5p max impairment/muscle)
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Passive range of motion in the lower extremity
Clinical assessment of range of motion with a goniometer
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
The 10 meter walk test
Assesses gait speed
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
6 minutes walk test
Assesses walking endurance in meters walked
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Rated Perceived Exertion (RPE) Scale
Ratings (min 6, max 20) according to the RPE scale are made at the end of the 6 minutes walk test.
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
The Functional Ambulation Categories (FAC)
Assesses independence in walking (0p nonfunctional, 5p independent) Total score 0-5p
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
The Balance evaluation systems test (BEST-test)
Assesses postural control, incorporating bio-mechanical systems, limits of stability, anticipatory postural adjustment, automatic postural responses, sensory orientation, stability in gait (0p max impairment summed up to 108p no impairment)
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Falls Efficacy Scale (FES-S)
Assesses self perceived balance in every day life activities rated on a 11 point scale (0p not safe at all 10p completely safe). Total score: 0- 130 p
Time frame: At baseline and at 3 and 6 months to assess change.
Navigated Transcranial magnetic stimulation (nTMS)
To estimate the integrity of the corticospinal tract, transcraniel magnetic stimulation will be applied to the primary motor cortex and motor evoked potentials will be will be recorded from the lower leg muscles using electromyography.
Time frame: At baseline and at 3 and 6 months to assess change.
The Montreal Cognitive Assessment (MoCa)
Assesses mental function (0p max impairment summed up to 30p no detected impairment)
Time frame: At baseline and at 3 and 6 months to assess change.
National Institute of Health Stroke Scale
To assess overall effects of stroke (ranging from 0-44 points, a higher score indicating more severe disability).
Time frame: At baseline and at 3 and 6 months to assess change.
Barthel Index
Assesses independence in mobility and personal care (0p dependent 10/15p independent) Total score 0-100p
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Monofilament
Measuring cutaneous sensory perception threshold under foot with a pressure of 4, 6 and 10 grams.
Time frame: At baseline, at 3 and 6 months to assess change.
Pain drawing
Self-assessed location and type of pain on the body
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Numeric rating scale of pain
Self-rated general intensity of pain at time of assessment (0 no pain, 10 worst imaginable pain)
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Medical Research Council scale
Assesses movement strength at a specific joint and motion (0 no muscle activity 5 normal force)
Time frame: At baseline, weekly during inpatient rehab and at 3 and 6 months to assess change.
Walking impact scale (Walk-12)
Measures rated limitations in walking activities (1 no limitation, 5 extreme limitation)
Time frame: At baseline and at 3 and 6 months to assess change
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