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Work-related upper extremity disorders (WRUEDs) are highly prevalent and costly. Development of fatigue is thought to be one of the causes of WRUEDs. Perceived fatigue can be assessed with the Borg CR Scale® (Borg CR10). The objective was to validate the Borg CR10 for the evaluation of shoulder perceived fatigue during lifting tasks. Seventy adults in working age performed three rhythmic lifting tasks with two loads (15% and 30% of maximal voluntary contraction). Using generalized repeated-measures ANOVA (Generalized Estimating Equations), statistically significant Task and Load effects (p < 0.001), as well as Task × Load interaction effects (p < 0.0001) were observed on Borg CR10, without any influence of sex. The Borg CR10 is a valid tool to assess shoulder perceived fatigue as it can discriminate between tasks of different difficulty levels in term of complexity, height, and resistance, regardless of sex., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Increased physical activity has been demonstrated as a relevant treatment after a stroke, with positive effects on impairment recovery, activity limitation, social participation and quality of life. Furthermore, PA is now recommended as part of the stroke recovery pathway, starting during inpatient care and extending through rehabilitation and community integration. The purpose of this presentation is to describe how current technologies may facilitate a continuity of care for stroke survivors. We present a synthesis of 8 studies that we have conducted to date to assess and monitor the activity level of post-stroke patients at home. The results of these studies show that home rehabilitation of post-stroke patients requires the use of individualized monitoring criteria to optimize patient care. To encourage the patient to increase his level of moderate physical activity and reduce his sedentary time, it would be recommended to propose a regularly monitored and structured program.

Background : Stroke causes psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Physical activity (PA) in stroke recovery is beneficial. The benefits of PA on quality of life after stroke are less documented. The aim of the study was to evaluate the effect of a home-based PA incentive program at home in post-stroke patients in the subacute phase on quality of life. Methods : This is a prospective, randomized, single-blind, and monocentric clinical trial. Eighty-three patients were randomly assigned to either an experimental group (EG; n = 42) or to a control group (CG; n = 41). The experimental group followed a home-based PA incentive program for 6 months. Three incentive methods were used: daily monitoring with an accelerometer, weekly telephone calls, and home visits every three weeks. Patients were evaluated before intervention (T0) and after intervention (T1) at 6 months. The control group was a non-intervention group receiving usual care. The outcome was the quality of life with the EuroQol EQ-5D-5L evaluated at baseline and 6 months post-intervention. Results : The mean age was 62.2 years ± 13.6 with a post-stroke time of 77.9 ± 45.1 days. The mean values of the utility index (EQ-5D-5L) in the control group and experimental group at T1 were 0.721 ± 0.207 and 0.808 ± 0.193, respectively ( p = 0.02). Discussion : Our study shows a significant difference in the Global QOL index (EQ-5D-5L) between the two groups of subacute stroke patients after 6 months of the individualized coaching program, which combined home visits and weekly telephone calls.

Background: Community stroke rehabilitation teams (CSRT) provide an individualized home-based rehabilitation service to patients recovering from stroke., Objective: To examine whether there is an improvement in the social participation of patients who received a rehabilitation program provided by CSRT. The secondary objectives were to show if there is an improvement in the patients' quality of life and a reduction in the caregiver burden., Methods: Retrospective cohort study, pragmatic in real-care conditions. The rehabilitation program delivered by the CSRT was adapted to the needs of the patients and caregivers. The outcome questionnaires included: the Frenchay Activity Index (FAI), the Minizarit, the EuroQol EQ5D, and the Barthel Index. The primary outcome measure was the FAI., Results: We included 206 patients followed by the CSRT over the 2018-2020 study period, for whom the primary endpoint was present. The mean age was 66.3 ± 12.7 years, the post-stroke delay was 16.4 ± 32.7 months, and the Barthel index was 66.42 ± 12.6. The duration of the rehabilitation program was on average 162 ± 109 days. We observed a significant improvement in the FAI, from 12.9 ± 10.4 to 17.85 ± 12.4 ( p < 0.00001); in the EuroQol, from 57.51 ± 19.96 to 66.36 ± 18.87 ( p < 0.00001); in the mini-Zarit, from 2.49 ± 1.75 to 2.06 ± 1.67 ( p = 0.0002); and in the Barthel index, from 66.42 ± 12.67 to 84.81 ± 23.70 ( p < 0.001)., Conclusion: Patients who received a rehabilitation program by the CSRT have an improvement in their social participation, and their informal caregivers have a reduction in their burden.

Objective: To assess the impact of cognitive Dual Task (DT) during walking on the energy cost of walking (Cw) in individuals with subacute stroke. The secondary objective was to determine whether there is an association between the Cw and cortical activity of the prefrontal area., Methods: Any individual with stroke localized in the temporal-parietal regions and able to walk without human assistance was included. Cw and prefrontal cortical activity, recorded by fNIRS, were measured during simple task walking activity and cognitive dual task during walking., Results: Nineteen individuals with stroke (age = 67.7 ± 9.6 yrs) were included. The cognitive DT during walking resulted in an increase in Cw of 23.1%; 95%CI [13.1%; 34.5%]. The increase in Cw in cognitive DT was correlated with the Cw for the single task walking activity (r = 0.48, p < 0.01) as well as the predominance of cortical activity of the prefrontal area in the contralesional hemisphere (r = -0.33, p < 0.01)., Conclusion: There is an increase in Cw during the cognitive DT. This increase is even more significant, as the Cw of the single task walking activity is high, and the cortical activity of the prefrontal areas predominates in the contralesional hemisphere.

The electromyography (EMG) cocontraction index (CCI) given by the antagonistic/agonistic Root Mean Square (RMS) amplitude ratio of the same muscle is a qualified biomarker used for spastic cocontraction quantification and management in cerebral palsy children. However, this normative EMG ratio is likely subject to a potential source of errors with biased estimates when measuring the gastrocnemius plantar flexors activity. Due to the uneven distribution of electrical activity within the muscle volume, cocontraction levels can be misestimated, if EMGs are obtained from the sole traditional bipolar sensor location recommended by SENIAM. This preliminary study, on 10 healthy children (mean age 10 yr), investigated whether surface EMG detected proximally and distally via two pairs of bipolar electrodes, within the medial gastrocnemius (MG), provides a significant difference in CCI estimates during non-dynamic (isometric dorsiflexion) and dynamic (swing phases of gait) conditions. Gait cycles were extracted from Inertial Measurement Unit sensors. Medial gastrocnemius activity was greater distally than proximally during plantar flexion when it acts as an agonist (~24±18%) and it was greater proximally during dorsiflexion (~23±9%) when it is acting as an antagonist. As a direct consequence, CCI estimates from the conventional sensor location were significantly different (~36%) from the CCIs computed by considering broader MG regions. This difference arose in all subjects during isometric efforts and in two of 10 healthy children during the swing phase of gait who presented cocontraction patterns ( [Formula: see text]). EMG bipolar sampling encompassing proximal and distal gastrocnemius muscle regions may reduce bias in CCI computation and provide a more representative and accurate cocontraction index that is especially important for comparisons to the diseased state.

Background and objective: Duration of rehabilitation and active participation are crucial for gait rehabilitation in the early stage after stroke onset. Virtual reality (VR) is an innovative tool providing engaging and playful environments that could promote intrinsic motivation and higher active participation for non-ambulatory stroke patients when combined with robot-assisted gait training (RAGT). We have developed a new, fully immersive VR application for RAGT, which can be used with a head-mounted display and wearable sensors providing real-time gait motion in the virtual environment. The aim of this study was to validate the use of this new device and assess the onset of cybersickness in healthy participants before testing the device in stroke patients. Materials and Methods: Thirty-seven healthy participants were included and performed two sessions of RAGT using a fully immersive VR device. They physically walked with the Gait Trainer for 20 min in a virtual forest environment. The occurrence of cybersickness, sense of presence, and usability of the device were assessed with three questionnaires: the Simulator Sickness Questionnaire (SSQ), the Presence Questionnaire (PQ), and the System Usability Scale (SUS). Results: All of the participants completed both sessions. Most of the participants (78.4%) had no significant adverse effects (SSQ < 5). The sense of presence in the virtual environment was particularly high (106.42 ± 9.46). Participants reported good usability of the device (86.08 ± 7.54). Conclusions: This study demonstrated the usability of our fully immersive VR device for gait rehabilitation and did not lead to cybersickness. Future studies should evaluate the same parameters and the effectiveness of this device with non-ambulatory stroke patients.

Objective: To evaluate the validity and test-retest reliability of physical activity trackers (accelerometer, multisensor, smartphone, pedometer) for estimating energy expenditure during walking in individuals with stroke., Data Sources: Webline, MEDLINE, Scopus, ScienceDirect, Bielefeld Academic Search Engine, and Wiley Online Library databases from 1980 to November 2020., Study Selection: The inclusion criteria were studies that examined the validity of portable physical activity trackers for estimating energy expenditure in individuals with stroke during walking activities compared to indirect calorimetry., Data Extraction: This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of the included studies was determined with the Quality Assessment of Diagnostic Accuracy Studies. The study selection was made by 2 blind observers., Data Synthesis: We screened 3677 articles; 3647 were excluded after duplicate removal and title and abstract review. Thirty articles were included for full-text analysis. Eight articles met the inclusion criteria (184 individuals with stroke) and were included in the data synthesis and meta-analysis. For all monitors, activities, and placements, the overall level of correlation with indirect calorimetry was 0.34 (95% confidence interval [CI], 0.23-0.44). After subgroups analysis, we showed that type and placement have no effect on the level of validity. Test-retest reliability was high, with intraclass correlation equal to 0.89 (95% CI, 0.76-0.95)., Conclusions: Portable physical activity monitors provided a low correlation with indirect calorimetry during walking in individuals with stroke. It seems essential to pursue studies to improve their validity in this population., (Copyright © 2022 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The increased energy cost of walking (Cw) for stroke patients affects the walking function and walking independence of stroke patients. However, its impact on quality of life (QoL) has never been studied., Objective: Assess the association between Cw and QoL for post-stroke individuals in the year following hospital discharge., Method: Thirty-seven individuals with stroke were included. QoL was assessed by the EuroQol-5 Dimensions on the day after hospital discharge (T0), at six months (T1) and at one year after hospital discharge (T2). Concomitant an evaluation of Cw, mood disorders (HADS), fatigue, independence in activities of daily living and the presence of a family caregiver was performed. The association between QoL and the different covariates was analyzed using multiple regression analysis., Results: At T2, data from 29 individuals were analyzable. Multiple regression analyses showed Cw had a significant influence on the QoL at T1 (coeff -0.42 (-0.71 to -0.12), P = .008) and T2 (coeff -0.49 (-0.71 to -0.26), P < .001). HADS score was the only other variable to significantly impact variances of QoL at T0, T1 and T2. Moreover, we showed that Cw at T0 explained 29% of variances of QoL at T1 and 42% at T2., Conclusion: Cw appears to be an independent factor in the QoL of individuals with stroke at six months and one year after hospital discharge. In addition, the initial Cw and HADS are predictive of QoL at one year highlighting the importance of early interventions in these two dimensions to improve QoL over the long term., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Autonomic imbalance in stroke is characterized by increased sympathetic activity and reduced vagal nerve activity. Physical activity could be a strategy to counteract autonomic control impairments after a stroke. The aim of the study was to evaluate the effect on heart rate variability of a 6-month coaching program in a home setting in subacute stroke patients. Eighty-four stroke patients participated in the study. They were randomly assigned to the experimental group or the control group. The intervention was a coaching program, consisting of physical activity, home visits and a weekly phone call. Patients were evaluated after hospital discharge (T0) and at the end of the 6-month period (T1). Heart rate variability measures were recorded in the supine and orthostatic positions. Time and frequency domain values were treated using Kubios. Distance on 6 minutes walking test (6MWT), Barthel and motricity index and modified functional ambulation categories were evaluated. No effects were found on time and frequency domain values in the supine and orthostatic positions in either group. Walking distance on 6MWT increased significantly between T0 and T1 in experimental group (377 ± 141-448 ± 140 m; P  < 0.02) with no effects in control group (373.6 ± 150.6-394.6 ± 176.4 m). No other functional effects were found. A coaching program in a home setting had no effect on heart rate variability, probably due to time of recovery and exercise intensity. Future research is needed to understand the lack of changes in heart rate variability by physical activity in subacute stroke patients., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Stroke is the leading cause of acquired disability in France. While 90% of patients recover the ability to walk, it is often limited with a steady speed of approximately 0.7 m/s. This limitation of walking activity is partly related to a decrease in strength associated with more or less significant spasticity. In particular, it seems that the strength of the dorsiflexor muscles is directly related to walking speed. We hypothesise that a protocol based on gestural repetition targeted at the ankle during the subacute phase potentiates the recovery of motor control, improving walking activity, and participates in recovering better social participation., Methods: An estimated total of 60 patients with subacute stroke will be recruited to participate in this multicentre, interventional, prospective, randomised controlled trial. All participants will benefit from conventional rehabilitation. In addition, the experimental group will take part in an ankle isokinetic rehabilitation programme for 6 weeks (at least 25 sessions). The control group will receive the same duration of conventional rehabilitation. The primary outcome measure will be a 10-m walking speed at post-intervention. Secondary outcomes will include social participation, walking spatio-temporal parameters, and dorsiflexor strength. Outcome measurements will be taken at baseline, immediately after treatment (6 weeks), then at 6 months and 1 year of follow-up., Discussion: This study aims to provide scientific evidence that a protocol based on an early over-solicitation of the ankle dorsiflexor muscles to promote their "awakening" can serve to achieve a more effective walking activity, which in turn encourages social participation following discharge from the hospital. This protocol should also help optimise physical medicine and rehabilitation practices: the more systematic use of the isokinetic dynamometer as a technique associated with, and integrated into the conventional rehabilitation protocol would allow an objective evaluation of the rehabilitation benefits and should increase the rehabilitation gain in central nervous system disorders., Trial Registration: Limoges University Hospital is the sponsor of this research (Unique Protocol ID: 87RI18&#95;0010) This research is supported by the French Ministry of Health (PHRC 2020-A03328-31) and is conducted with the support of DGOS (PHRC interregional - GIRCI SOHO). The study protocol was approved by the French Human Subjects Protection Review Board (Comité de Protection des Personnes Nord-Ouest III) on February 23, 2021. The trial was registered in the ClinicalTrials.gov registry ( NCT04800601 ) on March 16, 2021., (© 2022. The Author(s).)

Background: The integration of oxygen cost into the accelerometer's algorithms improves accuracy of total energy expenditure (TEE) values as post-stroke individuals walk. Recent work has shown that oxygen cost can be estimated from specific prediction equations for stroke patients., Objective: The objective is to the validity of the different oxygen cost estimation equations available in the literature for calculating TEE using ActigraphGT3x as individuals with stroke sequelae walk., Method: Individuals with stroke sequelae who were able to walk without human assistance were included. The TEE was calculated by multiplying the walking distance provided by an ActigraphGT3x worn on the healthy ankle and the patient's oxygen cost estimated from the selected prediction equations. The TEE values from each equation were compared to the TEE values measured by indirect calorimetry. The validity of the prediction methods was evaluated by Bland-Altman analysis (mean bias (MB) and limits of agreement (LoA) values)., Results: We included 26 stroke patients (63.5 years). Among the selected equations, those of Compagnat and Polese obtained the best validity parameters for the ActigraphGT3x: MB Compagnat = 1.2 kcal, 95% LoA Compagnat = [-12.0; 14.3] kcal and MB Polese = 3.5 kcal, 95% LoA Polese = [-9.2; 16.1] kcal. For comparison, the estimated TEE value according to the manufacturer's algorithm reported MB Manufacturer = -15 kcal, 95% LoA Manufacturer = [-52.9; 22.8] kcal., Conclusion: The Polese and Compagnat equations offer the best validity parameters in comparison with the criterion method. Using oxygen cost prediction equations is a promising approach to improving assessment of TEE by accelerometers in post-stroke individuals.

Background: The oxygen cost of walking (Cw) represents the energy expenditure involved in walking, which is a major concern when quantifying physical activity in stroke. Recent studies have reported that Cw may be estimated accurately with a prediction equation using the self-self-selected walking speed (S free )., Research Question: To evaluate the validity of Cw estimates according to different modalities of S free measurements (10-m walking test, 6-minute walking test, GaitRite system)., Methods: Twenty-one stroke individuals in subacute phase who were able to walk without human aid were included. Cw was estimated from the walking speed measured during a 10-m walking test, a 6-minute walking test and a recording on a GaitRite system. The values of the Cw estimates were compared to those measured by a respiratory gas exchange analyzer (Metamax3b)., Results: The findings showed that there is no significant difference between the Cw measured by Metamax3b and the Cw estimates regardless of the modalities used to measure S free (Fvalue = 0.02; pvalue = 0.99). The mean bias between Cw measured by the Metamax3b and those estimated using the different S free measurement modalities was less than 2.5 % of the mean Cw value. Test retest reliability was excellent with an intraclass correlation coefficient higher than 0.95., Significance: in stroke survivors who are able to walk independently without human aid, the use of a 10-m walking test, a 6-minute walking test or a GaitRite recording can be considered validated for estimating Cw., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Aim: To test the validity of Borg's 6-20 rating of perceived exertion scale in assessing the exertion intensity over a multi-activity session in young and older adults.Materials and methods: This cross-sectional study included 56 healthy participants. All participants underwent a single session of activities including working on a computer, treadmill walking, biking, and treadmill running., Results: Results showed a non-significant correlation between the overall perceived exertion and energy expenditure in young people (Rho=-0.05, p=0.75) and in older adults (Rho=-0.05, p=0.78) for the whole session. However, results showed that older adults perceived significantly higher exertion compared to young people while working on a computer, walking and running, whereas they presented lower energy expenditure while resting and working on a computer., Conclusions: Combining the perceived exertion method with other commonly used methods to estimate exercise intensity would be recommended for older adults., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To evaluate the association between self-selected walking speed (S free ), oxygen consumption at S free (Vo 2free ), the oxygen cost of walking (Cw) at S free , and mobility independence and independence for activities of daily living in individuals poststroke., Design: Cross-sectional study., Setting: Hospital., Participants: Individuals with stroke who were able to walk without human assistance were included. We included 90 individuals (N=90; mean age, 63.5±14.0y)., Interventions: Not applicable., Main Outcome Measures: Cw was captured during walking from measurements of S free and Vo 2free . We assessed mobility independence based on the modified Functional Ambulation Classification (mFAC) and independence in activities of daily living by the Barthel Index (BI). Multiple linear regression analyses were performed to evaluate the independence of Cw, Vo 2free , and S free from the determination of BI and mFAC among the various characteristics of the population (age, stroke delay, body mass index, motor function, spasticity)., Results: We reported Cw=0.36 mL/kg/m (interquartile range [IQR]=0.28 mL/kg/m), S free =0.60±0.32 m/s, Vo 2free =11.2 mL/kg/min (IQR=1.8 mL/kg/min). The multiple linear regression analyses showed that Cw and S free were independently associated with the BI (P<.01) and the mFAC (P<.01) scores. Vo 2free was not found to be an explanatory variable of functional independence (P>.05)., Conclusions: Cw was independently associated with functional independence. This association appears to be primarily determined by S free and not Vo 2free , underscoring the importance of evaluating and acting on S free to improve the functional independence of individuals with stroke., (Copyright © 2021 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The gains in walking capacity achieved during rehabilitation often plateau, or are lost, when the patient returns home. Moreover, maintaining or increasing the patient's daily physical activity level after a stroke remains challenging. We aimed to evaluate the effectiveness of a six-month individualized coaching program at home on walking capacity, as evaluated by the six-minute walk test in subacute stroke patients., Methods: Stroke patients in the physical medicine and rehabilitation service participated in a monocentric observer blinded randomized controlled trial with two groups, intervention versus usual care control. The inclusion criteria were: age≥18 years, first ischemic or hemorrhagic stroke, and stroke within<6 months. Participants were randomly assigned (blocks of variable size) to an intervention group (EG) receiving individualized coaching on physical activity, or to a control group (CG) receiving standard care. The six-month program was composed of monitored physical activity, home visits and a weekly phone call. Participants were evaluated after hospital discharge (T0), at the end of the six-month program (T1) and six months later(follow-up; T2). The primary outcome was the walking distance performance, as evaluated with the six-minute walk test at T1., Results: Eighty-three participants (age: 61y [IQR=22]; time post-stroke: 2.4 month [IQR=1.7]; Barthel index: 100[IQR=5]) were included in the study: (EG, n=41; CG, n=42). The difference between the two groups was not significant at T1(418m [IQR=165] for the EG and 389m [IQR=188] for the CG; P=0.168) and at T2(425m [IQR=121] for the EG vs. 382m [IQR=219] for the CG; P=0.208)., Conclusion: Our study shows no difference in the six-minute walk test between the two groups of subacute stroke patients after 6 months of the individualized coaching program, combining home visits, feedback on daily performance and weekly telephone calls. http://ClinicalTrials.gov (NCT01822938)., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: The current coronavirus disease (COVID-19) pandemic makes it difficult to obtain physical therapy in rehabilitation centres, particularly for persons with multiple sclerosis (pwMS), who are a population at high risk, since viral infections may contribute to MS exacerbations and relapses. Active video games could be a way to maintain physical therapy at home as part of the rehabilitation. The aim of this review is to summarise the current best evidence for the effectiveness of home-based active video games on gait and balance, user compliance, feasibility and safety for pwMS., Methods: We searched for studies in five databases (PubMed, Scopus, Cochrane, CINAHL and Science direct) up to October 2020. Selection of studies, extraction of data and methodological quality assessment through the PEDro scale were made independently by two authors and discussed with a third author., Results: Nine studies were included in this systematic review. We found significant improvements in balance; results were mixed concerning mobility, physical activity and gait. Home-based active video games are feasible and safe, with good compliance and adherence. The methodological quality of the studies was moderate (PEDro scale: 5.3 ± 2)., Conclusion: Overall, home-based active video games were found safe and effective improving static and dynamic balance in pwMS. Compliance was good, probably because it is a motivating and enjoyable training. Active video games can be a relevant alternative for physical rehabilitation at home in pwMS. Future studies should follow more rigorous methodological standards (larger sample sizes, more randomised controlled trials) to improve the quality of evidence and include cost-effectiveness in the analysis., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021. Published by Elsevier B.V.)

Increasing cerebral oxygenation, more precisely the overactivation of the prefrontal cortex (PFC), reflects cortical control of gait in stroke disease. Studies about the relationship between brain activation and the functional status in stroke patients remain scarce. The aim of this study was to compare brain activation, gait parameters, and cognitive performances in single and dual tasks according to the functional status in subacute stroke patients. Twenty-one subacute stroke patients were divided in two groups according to Barthel Index ("low Barthel" and "high Barthel") and randomly performed ordered walking, cognitive task (n-back task), and dual tasks (walking + n-back task). We assessed gait performances (speed, variability) using an electronic walkway system and cerebral oxygenation (ΔO 2 Hb) by functional near-infrared spectroscopy. Patients with better functional status (high Barthel) showed a lower PFC activation (ΔO 2 Hb) and better gait parameters in single and dual tasks compared to low-Barthel patients, who exhibited decreased gait performances despite a higher PFC activation, especially in the unaffected side ( P < 0.001). PFC overactivation in less functional subacute stroke patients may be due to the loss of stepping automaticity. Our results underline the interest of proposing rehabilitation programs focused on walking, especially for patients with low functional capacity., (Copyright © 2020 Hermand, Compagnat, Dupuy, Salle, Daviet and Perrochon.)

Background . Understanding the factors that limit mobility in stroke patients is fundamental for proposing appropriate rehabilitation strategies. A high oxygen cost during walking (Cw) has a strong impact on the community ambulation of hemiparetic patients. The Cw in poststroke cerebellar ataxia is poorly evaluated, unlike hemiparetic gait. Objective . To compare the oxygen cost/self-selected walking speed (S) relationship in stroke individuals with cerebellar ataxia or hemiparetic gait. Methods . Thirty-three subjects were included (14 cerebellar stroke, 19 hemispheric stroke), with stroke confirmed by brain imaging and able to walk without human assistance. We measured Cw using the Metamax3B. The relationship between Cw and self-selected walking speed was modelled by logistic regression and then compared between the cerebellar and hemispheric groups. Results . No significant difference was found between the 2 groups for all characteristics of the population, except motor impairments, spasticity, and ataxia ( P < .01). We identified 2 separate Cw/S relationships with different logistic regression equations for the 2 groups. Faster than 0.4 m s -1 , Cw was 30.6% to 39.9% higher in patients with cerebellar stroke in comparison with hemispheric stroke individuals. The Cw was correlated with ataxia ( r = 0.88; P < .001) in the cerebellar group, whereas there was a correlation with motor impairments ( r = -0.61; P < .01), spasticity ( r = 0.59; P < .01), and ataxia ( r = 0.81; P < .01) in hemispheric stroke individuals. Conclusion . The Cw in poststroke cerebellar ataxia is significantly higher compared with hemiparetic patients at an equivalent walking speed. The impact on community walking needs to be explored in stroke survivors with cerebellar stroke.

Objective: The objective of this review was to summarize the current best evidence for the effectiveness, feasibility, user compliance and safety of exercise-based games (EBGs), including virtual reality and interactive video game interventions, for the rehabilitation of individuals with neurological disorders at home., Material and Methods: We identified randomized controlled trials (RCT) evaluating the effects of EBGs in neurological patients in home settings by searching 3 electronic databases (MEDLINE, SCOPUS, CENTRAL Library) from inception to March 2018. All data pertaining to participants, interventions, outcomes, supervision and cost-effectiveness were independently extracted by 2 reviewers. Risk of bias was independently assessed by 2 reviewers., Results: Reports of 11 RCT studies with heterogeneous populations (i.e., stroke, Parkinson disease and multiple sclerosis) were included in the review. The treatment of experimental groups included EBGs (i.e., commercially available games such as Nintendo Wii or Dance Dance Revolution or custom-designed devices), and control groups received a controlled (i.e., conventional therapy) or uncontrolled (i.e., usual care) intervention. Across studies, EBGs at home tended to have limited effects on upper and lower limbs. We demonstrated an increased risk of participants dropping out of the program or discontinuing training in experimental groups (n=51 participants) as compared with controls (n=23 participants). Few adverse events (2 of 6 studies), such as minor musculoskeletal pain, were reported in balance training., Conclusions: This systematic review reveals that EBGs seem a relevant alternative for rehabilitation at home because the effectiveness of these interventions was at least equivalent to conventional therapy or usual care. We give recommendations for the development of new EBG therapies., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Stroke patients often exhibit difficulties performing a cognitive task while walking, defined as a dual task (DT). Their prefrontal cortex (PFC) activity is higher in DT than in single task (ST). The effects of an increasing load on PFC activity during DT in subacute stroke patients remains unexplored. Our objective was to assess the effects of N-back tasks (low/high load) on cerebral activity, gait parameters, and cognitive performances. Eleven subacute stroke patients (days post-stroke 45.8 ± 31.6) participated in this pilot study (71.4 ± 10 years, BMI 26.7 ± 4.8 kg.m -2 , Barthel index 81.8 ± 11.0). Patients completed a ST walk , and 4 conditions with 1-back (low load) and 2-back (high load): ST low , ST high , DT low , and DT high . Overground walking was performed at a comfortable pace and -N-back conditions were carried out verbally. Both gait (speed, stride variability) and cognitive (rate of correct answers) performances were recorded. Changes in PFC oxyhemoglobin (ΔO 2 Hb) and deoxyhemoglobin (ΔHHb) were measured by functional near infrared spectroscopy (fNIRS). Results showed an increase of ΔO 2 Hb while walking, which was not augmented by cognitive loads in DT. Walking speed was reduced by low and high cognitive loads in DT compared to ST walk ( P < 0.05), but was not different between DT low and DT high . Cognitive performances were negatively impacted by both walking ( P < 0.05) and cognitive load (between "low" and "high," P < 0.001). These data highlight a "ceiling" effect in ΔO 2 Hb levels while walking, leaving no available resources for simultaneous cognitive tasks, during the early recovery period following stroke. In these patients, cognitive, but not motor, performances declined with a higher cognitive load.

Objective: To determine whether post-stroke patient's perceived exertion correlates with effort intensity score as measured by a wearable sensor and to assess whether estimates of perceived exertion are correlated to the cerebral hemisphere involved in the stroke., Methods: We evaluated the effort intensity score during physiotherapy sessions using a wearable sensor and subjects assessed their perceived exertion using the modified Borg CR10 Scale., Results: Fifty-seven subacute stroke patients participated in the study. The correlation between perceived exertion rating and measured effort intensity was insignificant-mean (r=-0.04, p=0.78) and peak (r=-0.05, p=0.70). However, there was a significant difference (p<0.02) in the perceived exertion ratings depending on the cerebral hemisphere where the stroke occurred. Patients with left-hand side lesions rated their perceived exertion as 4.5 (min-max, 0.5-8), whereas patients with right-hand side lesions rated their perceived exertion as 5.0 (2-8)., Conclusion: While there was an insignificant correlation between perceived exertion and effort intensity measured by a wearable sensor, a consistent variations in perceived exertion estimates according to the side of the cerebral lesion was identified and established.