Therapeutic effectiveness of a single exercise session combined with WalkAide functional electrical stimulation in post-stroke patients:a crossover design study

A growing body of evidence has suggested that the imbalance of epigenetic markers and oxidative stress appears to be involved in the pathophysiology and progression of stroke.Thus,strategies that modulate these biomarkers might be considered targets for neuroprotection and novel therapeutic opportunities for these patients.Physical exercise has been reported to induce changes in these epigenetic markers and improve clinical outcomes in different populations.However,little is reported on this in post-stroke patients.The purpose of this study was to investigate the effect of a single exercise session with WalkAide functional electrical stimulation(FES)on cognitive performance,clinical functional parameters,oxidative stress and epigenetic modulation in post-stroke individuals.In this crossover design study,12 post-stroke individuals aged 54–72 years of either sexes were included and subjected to a single session of exercise(45 minutes)without WalkAide functional electrical stimulation(EXE alone group),followed by another single session of exercise(45 minutes)with WalkAide functional electrical stimulation(EXE+FES group).The clinical functional outcome measures,cognitive performance and blood collections for biomarker measurements were assessed pre-and post-intervention.After intervention,higher Berg Balance Scale scores were obtained in the EXE+FES group than in the EXE alone group.There was no significant difference in the Timed Up and Go test results post-intervention between EXE alone and EXE+FES groups.After intervention,a better cognitive performance was found in both groups compared with before the intervention.After intervention,the Timed Up and Go test scores were higher in the EXE+FES group than in the EXE alone group.In addition,the intervention induced lower levels of lipid peroxidation.After intervention,carbonyl level was lower,superoxide dismutase activity and superoxide dismutase/catalase activity ratio were higher in the EXE+FES group,compared with the EXE group alone.In each group,both histone deacetylase(HDAC2)and histone acetyltransferase activities were increased after intervention compared with before the intervention.These findings suggest that a single exercise session with WalkAide FES is more effective on balance ability and cognitive performance compared with conventional exercise alone in post-stroke patients.This is likely to be related to the regulation of oxidative stress markers.The present study was approved by the Research Ethics Committee of the Methodist University Center-IPA(approval No.2.423.376)on December 7,2017 and registered in the Brazilian Registry of Clinical Trials—ReBEC(RBR-9phj2q)on February 11,2019.

Postural control quantification in minimally and moderately impaired persons with multiple sclerosis:The reliability of a posturographic test and its relationships with functional ability

Background:Postural control has been associated with the functional impairment in persons with multiple sclerosis(pwMS).However,there is a need for reliable methods to assess postural control in early stages of the disease,when subtle changes can be difficult to detect.The aims of this study were to assess the absolute and relative reliability of a standing and a sitting posturographic protocol in minimally(Expanded Disability Status Scale≤2)and moderately(2.5≤Expanded Disability Status Scale≤4)impaired pwMS,and to analyze relationships among postural control and functional mobility and gait performance.Methods:To assess postural control in an upright stance,14 minimally and 16 moderately impaired pwMS performed six 70 s trials in tandem stance,3 with their weaker leg behind(TSWL)and 3 with their stronger leg behind(TSSL).Additionally,participants completed five 70 s trials using an unstable sitting protocol(US)to assess trunk stability.The mean radial errors of TSWL,TSSL,and US trials were calculated as postural control indexes.Furthermore,participants performed the Timed Up and Go test(TUG)and the Timed 25-foot Walk test(T25FW)to measure their functional mobility and gait speed,respectively.Reliability was evaluated using the intraclass correlation coefficient(ICC3,1)and the standard error of measurement(SEM).Analyses of variances were carried out to assess between-group differences.Hedges’g index(dg)was used to estimate the effect size of differences.Pearson correlation analyses(r)were performed to examine the relationships among the postural control and the functional tests.Results:Posturographic tests showed a high reliability in both minimally(0.87≤ICC≤0.92;9.32%≤SEM≤11.76%)and moderately(0.80≤ICC≤0.92;10.33%≤SEM≤15.33%)impaired pwMS.Similarly,T25FW and TUG displayed a high consistency in minimally(0.89≤ICC≤0.94;3.43%≤SEM≤5.17%)and moderately(0.85≤ICC≤0.93;5.57%≤SEM≤6.56%)impaired individuals.Minimally impaired pwMS showed a better performance on the TUG,T25FW,and TSWL than moderately impaired individuals(p<0.05;dg≥0.8).The TSWL,TSSL,and US variables correlated with TUG scores(0.419≤r≤0.604;p<0.05),but TSWL also correlated with T25FW scores(r=0.53;p<0.01).Furthermore,US scores correlated with both tandem stance parameters(TSWL:r=0.54,p<0.01;TSSL:r=0.43,p<0.05).Conclusion:Tandem and sitting posturographic tests provide reliable measures of postural control in pwMS,even in individuals with a homogeneous disease profile.Gait speed,functional mobility,and weaker leg status seem decisive in assessing the degree of physical activity limitation in pwMS.Finally,although trunk stability does not seem to be so affected by the course of the disease,it remains relevant for postural control and functional capacity.