Stroke-related deficits can impede both functional performance and walking tolerance. Individuals... more Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. Twelve participants (5 male) with a mean age of 60.6 +/- 14.5 years and 69.1 +/- 82.2 months post stroke participated in the training intervention. All participants performed SLE using the hemiparetic leg three times a week for 4 weeks. The nonhemiparetic limb served as the control limb and did not engage in SLE. Peak oxygen uptake (VO2 peak) and oxygen uptake (VO2) were measured at baseline and post intervention in all 12 participants. At pre and post intervention, gait velocity was assessed in a subset of participants (n = 7) using the 10-m fast-walk test. After the 4-week SLE training intervention, significant improvements were found for VO2 during submaximal work effort (P = .009) and gait velocity (n = 7) (P = .001). Peak oxygen uptake did not increase (P = .41) after the training intervention. These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.
ABSTRACT New technology such as virtual reality may have useful applications for improving rehabi... more ABSTRACT New technology such as virtual reality may have useful applications for improving rehabilitative care for people after stroke. The purpose of this review was to examine the research that currently exists regarding the use of virtual reality for stroke rehabilitation and discuss its potential for use in the future. Eight papers were identified from a database search. One study used a randomized controlled trial design while the others were case reports or small group descriptive studies. The application of virtual reality for stroke rehabilitation is still in its infancy and presently the strength of evidence is poor. Many questions remain unanswered, and further investigation is warranted as the technology develops to determine if virtual reality has advantages over traditional rehabilitation approaches for people with disabilities after stroke.
The primary impairments associated with Parkinson's disease occur in combination with the... more The primary impairments associated with Parkinson's disease occur in combination with the secondary, preventable effects of immobility. A community-based fitness program may help increase activity and maintain function in people in the early or middle stages of the disease. This article describes a unique program designed to reduce fall risk and promote independent exercise for people with Parkinson's disease. Two 66-year-old males, both community ambulators and in early or middle stages of Parkinson's disease, participated in 3 months of various physical activities. Group balance classes were held twice weekly during the first month, participants joined a fitness center and self-directed their exercise program during the second month, and group Tai Chi classes were held twice weekly during the third month. At conclusion of the program, participants were given suggestions for continued physical fitness activities. After the 3-month program, improvements were noted for both individuals in functional reach, Timed Up and Go, and Berg Balance scores. Both participants continued to exercise regularly for at least 8 months following the program. Two individuals with Parkinson's disease demonstrated improvement in their balance test performance over a 3-month period. Perhaps most importantly, these participants independently continued exercising after completing this program.
The purpose of this pilot study was to assess the feasibility and effectiveness of an intense hea... more The purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness. Various recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 +/- 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (alpha = .05). Following the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy. A systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy.
After stroke, individuals have decreased mobility of the hemiparetic leg, which demands less musc... more After stroke, individuals have decreased mobility of the hemiparetic leg, which demands less muscle oxygen consumption; thus, blood flow decreases. The purpose of this study was to determine the effect of single limb exercise (SLE) on femoral artery blood flow, diameter, and peak flow velocity in the hemiparetic leg after stroke. Twelve individuals (60.6+/-14.5 years of age; 5 male) with chronic stroke (69.1+/-82.2 months; 5 with right-sided hemiparesis) participated in the study. The intervention consisted of a SLE knee extension/flexion protocol 3 times per week for 4 weeks. Using Doppler ultrasound, bilateral femoral artery blood flow, diameter, and peak flow velocity were assessed at baseline, after 2 weeks, and after 4 weeks of SLE. Using repeated-measures analysis of variance, femoral artery blood flow, arterial diameter, and blood flow velocity in the hemiparetic limb were significantly improved (P<0.0001) after the SLE. No significant changes occurred in the nontrained limb for any outcome measures. These data suggest that a 4-week SLE training program that increases muscular activity in the hemiparetic limb improves femoral artery blood flow, diameter, and peak velocity. SLE may be an important training strategy in stroke rehabilitation to minimize the vascular changes that occur poststroke due to decreased activity of the hemiparetic limb.
Body system impairments following stroke have a complex relationship with functional activities. ... more Body system impairments following stroke have a complex relationship with functional activities. Although gait and balance deficits are well-documented in people after stroke, the overlapping influence of body impairments makes it difficult to prioritize interventions. This study examined the relationship between prospectively selected measures of body function and structure (body mass index, muscle strength, sensation, and cognition) and activity (gait speed, gait endurance, and functional balance) in people with chronic stroke. This was a cross-sectional, observational study. Twenty-six individuals with mean (SD) age of 57.6 (11) years and time after stroke of 45.4 (43) months participated. Four variables (body mass index, muscle strength difference between the lower extremities, sensation difference between the lower extremities, and Mini-Mental Status Exam score) were entered into linear regression models for gait speed, Six-Minute Walk Test distance, and Berg Balance Scale score. Lower-extremity strength difference was a significant individual predictor for gait speed, gait endurance, and functional balance. Cognition significantly predicted only gait speed. The authors did not include all possible factors in the model that may have influenced gait and balance in these individuals. Strength deficits in the hemiparetic lower extremity should be an important target for clinical interventions to improve function in people with chronic stroke.
Stroke-related deficits can impede both functional performance and walking tolerance. Individuals... more Stroke-related deficits can impede both functional performance and walking tolerance. Individuals with hemiparesis rely on the stronger limb during exercise and functional tasks. The single limb exercise (SLE) intervention was a unique training protocol that focused only on the hemiparetic limb. Our objective was to determine the effect of the SLE intervention on cardiorespiratory fitness parameters. Twelve participants (5 male) with a mean age of 60.6 +/- 14.5 years and 69.1 +/- 82.2 months post stroke participated in the training intervention. All participants performed SLE using the hemiparetic leg three times a week for 4 weeks. The nonhemiparetic limb served as the control limb and did not engage in SLE. Peak oxygen uptake (VO2 peak) and oxygen uptake (VO2) were measured at baseline and post intervention in all 12 participants. At pre and post intervention, gait velocity was assessed in a subset of participants (n = 7) using the 10-m fast-walk test. After the 4-week SLE training intervention, significant improvements were found for VO2 during submaximal work effort (P = .009) and gait velocity (n = 7) (P = .001). Peak oxygen uptake did not increase (P = .41) after the training intervention. These data suggest that SLE training was an effective method for improving oxygen uptake and reducing energy expenditure during submaximal effort. Unilateral exercise focused on the hemiparetic leg may be an effective intervention strategy to consider for stroke rehabilitation.
ABSTRACT New technology such as virtual reality may have useful applications for improving rehabi... more ABSTRACT New technology such as virtual reality may have useful applications for improving rehabilitative care for people after stroke. The purpose of this review was to examine the research that currently exists regarding the use of virtual reality for stroke rehabilitation and discuss its potential for use in the future. Eight papers were identified from a database search. One study used a randomized controlled trial design while the others were case reports or small group descriptive studies. The application of virtual reality for stroke rehabilitation is still in its infancy and presently the strength of evidence is poor. Many questions remain unanswered, and further investigation is warranted as the technology develops to determine if virtual reality has advantages over traditional rehabilitation approaches for people with disabilities after stroke.
The primary impairments associated with Parkinson's disease occur in combination with the... more The primary impairments associated with Parkinson's disease occur in combination with the secondary, preventable effects of immobility. A community-based fitness program may help increase activity and maintain function in people in the early or middle stages of the disease. This article describes a unique program designed to reduce fall risk and promote independent exercise for people with Parkinson's disease. Two 66-year-old males, both community ambulators and in early or middle stages of Parkinson's disease, participated in 3 months of various physical activities. Group balance classes were held twice weekly during the first month, participants joined a fitness center and self-directed their exercise program during the second month, and group Tai Chi classes were held twice weekly during the third month. At conclusion of the program, participants were given suggestions for continued physical fitness activities. After the 3-month program, improvements were noted for both individuals in functional reach, Timed Up and Go, and Berg Balance scores. Both participants continued to exercise regularly for at least 8 months following the program. Two individuals with Parkinson's disease demonstrated improvement in their balance test performance over a 3-month period. Perhaps most importantly, these participants independently continued exercising after completing this program.
The purpose of this pilot study was to assess the feasibility and effectiveness of an intense hea... more The purpose of this pilot study was to assess the feasibility and effectiveness of an intense health promotion program in older adults with diabetes. The program combined individually prescribed and supervised exercise with nutrition and education programs on glycemic control and aerobic fitness. Various recruitment and retention strategies were analyzed for effectiveness. Out of 28 potential subjects assessed for eligibility, 6 subjects with type 2 diabetes (2 male and 4 female; all white; age, 60.2 +/- 4.7 years) participated in the 10-week intervention. Aerobic and resistance exercise was performed on alternate days (3-4 days per week), with individualized nutrition counseling and diabetes health education sessions once weekly. The primary outcome measures were aerobic fitness and glycemic control (A1C), and secondary outcome measures included body mass index (BMI), self-efficacy, and symptoms of neuropathy. Changes in outcomes were assessed using descriptive statistics and paired t test analysis (alpha = .05). Following the intervention, subjects had improvements that approached significance in A1C and pain, with significant improvements in self-efficacy. A systematic approach to analysis of feasibility revealed issues with recruitment and retention that would need to be addressed for future studies or clinical implementation of this program. However, for the subset of subjects who did complete the intervention, adherence was excellent, and satisfaction with the program was confirmed by exit interview comments. Following participation in this pilot health promotion program, subjects had meaningful improvements in glycemic control, pain, and self-efficacy.
After stroke, individuals have decreased mobility of the hemiparetic leg, which demands less musc... more After stroke, individuals have decreased mobility of the hemiparetic leg, which demands less muscle oxygen consumption; thus, blood flow decreases. The purpose of this study was to determine the effect of single limb exercise (SLE) on femoral artery blood flow, diameter, and peak flow velocity in the hemiparetic leg after stroke. Twelve individuals (60.6+/-14.5 years of age; 5 male) with chronic stroke (69.1+/-82.2 months; 5 with right-sided hemiparesis) participated in the study. The intervention consisted of a SLE knee extension/flexion protocol 3 times per week for 4 weeks. Using Doppler ultrasound, bilateral femoral artery blood flow, diameter, and peak flow velocity were assessed at baseline, after 2 weeks, and after 4 weeks of SLE. Using repeated-measures analysis of variance, femoral artery blood flow, arterial diameter, and blood flow velocity in the hemiparetic limb were significantly improved (P<0.0001) after the SLE. No significant changes occurred in the nontrained limb for any outcome measures. These data suggest that a 4-week SLE training program that increases muscular activity in the hemiparetic limb improves femoral artery blood flow, diameter, and peak velocity. SLE may be an important training strategy in stroke rehabilitation to minimize the vascular changes that occur poststroke due to decreased activity of the hemiparetic limb.
Body system impairments following stroke have a complex relationship with functional activities. ... more Body system impairments following stroke have a complex relationship with functional activities. Although gait and balance deficits are well-documented in people after stroke, the overlapping influence of body impairments makes it difficult to prioritize interventions. This study examined the relationship between prospectively selected measures of body function and structure (body mass index, muscle strength, sensation, and cognition) and activity (gait speed, gait endurance, and functional balance) in people with chronic stroke. This was a cross-sectional, observational study. Twenty-six individuals with mean (SD) age of 57.6 (11) years and time after stroke of 45.4 (43) months participated. Four variables (body mass index, muscle strength difference between the lower extremities, sensation difference between the lower extremities, and Mini-Mental Status Exam score) were entered into linear regression models for gait speed, Six-Minute Walk Test distance, and Berg Balance Scale score. Lower-extremity strength difference was a significant individual predictor for gait speed, gait endurance, and functional balance. Cognition significantly predicted only gait speed. The authors did not include all possible factors in the model that may have influenced gait and balance in these individuals. Strength deficits in the hemiparetic lower extremity should be an important target for clinical interventions to improve function in people with chronic stroke.
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Papers by Patricia Kluding