Author: Lau, Wai-kin
Title: Osteogenic index of different exercises for subjects with stroke
Degree: M.Sc.
Year: 2008
Subject: Hong Kong Polytechnic University -- Dissertations.
Cerebrovascular disease -- Patients -- Rehabilitation.
Department: Department of Rehabilitation Sciences
Pages: x, 100 leaves : ill. ; 30 cm.
Language: English
Abstract: Stroke patients have increased risk of fractures and these commonly occurred on the hemiplegic side. The combination of increased falls and reduced bone mineral density may result in the high risk of fractures. Previous studies found that pharmacological intervention may help in reduction of the bone loss, thus reserve the bone mineral density and prevent fractures. However, it also reported of numerous of side effects. Exercise interventions were another method suggested to be effective in promoting bone health in elderly. To investigate the effectiveness of the exercises intervention, loading frequency and loading cycles are important to determine the strength of loading response. The degrees of impairment levels after stroke are also affecting the performance of exercises. However, no current study quantifies the loading of the exercises in the patients with stroke. Turner & Robling (2003) has proposed a mathematical model to estimate the osteogenic potential of different loading protocols, called the osteogenic index (OI). The aim of this study was to determine the OI of different exercises for stroke patients with different levels of lower extremity motor impairment. Forty-nine subjects aged from 50-80 years (mean=61.0 +- 7.0) were recruited in this study. Subjects were divided into two groups, less impaired group and more impaired group, according to their leg motor impairment levels of the hemiparetic side which assessed by the Chedoke-McMaster Stroke Assessment (CMSA). Subjects were required to perform 7 exercises for stroke patients commonly prescribed by the clinicians, including (1) walking with self selected speed (SSSW), (2) walking with maximum safe speed (MSSW), (3) stepping using the non-paretic leg onto a 4-inch step while weightbearing on the paretic leg (STEP4), (4) stepping using the non-paretic leg onto a 6-inch step while weightbearing on the paretic leg (STEP6), (5) sit to stand (STS), (6) marching on the spot (MARCH), and jumping (JUMP). The peak ground reaction forces (GRF) on the paretic side of the different exercises were measured by the floor-mounted multiaxial force platform. Loading cycles of each exercise were recorded in one-minute time and the OI were calculated. Result showed that only 26 subjects were able to perform all seven exercises. Another 23 subjects (total 49 subjects) could perform all the exercises except jumping. For all the exercises (expect jumping) stroke patients with less leg motor impairment tended to have higher OI value than the more impaired group. For the patients with less leg motor impairment, stepping and walking with maximal speed had significantly higher OI than the other exercises. While for the patients with more leg motor impairment, stepping had the higher OI than the other exercises. For the patients who could jump, the OI was not significantly different than the other exercises except sit to stand. In summary, stepping and brisk walking program can be recommended for patients with less leg motor impairment while only stepping is recommended for those with more leg motor impairment. Further study is required to determine the effectiveness of the exercises protocols on improving bone health in patients with stroke.
Rights: All rights reserved
Access: restricted access

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