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The impact of visuospatial and executive function on activity performance and outcome after robotic or conventional gait training, long-term after stroke—as part of a randomized controlled trial
Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.
Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0001-7543-4397
Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 3, article id e0281212Article in journal (Refereed) Published
Abstract [en]

Introduction: Visuospatial and executive impairments have been associated with poor activity performance sub-acute after stroke. Potential associations long-term and in relation to outcome of rehabilitation interventions need further exploration.

Aims: To explore associations between visuospatial and executive function and 1) activity performance (mobility, self-care and domestic life) and 2) outcome after 6 weeks of conventional gait training and/or robotic gait training, long term (1–10 years) after stroke.

Methods: Participants (n = 45), living with stroke affecting walking ability and who could perform the items assessing visuospatial/executive function included in the Montreal Cognitive Assessment (MoCA Vis/Ex) were included as part of a randomized controlled trial. Executive function was evaluated using ratings by significant others according to the Dysexecutive Questionnaire (DEX); activity performance using 6-minute walk test (6MWT), 10-meter walk test (10MWT), Berg balance scale, Functional Ambulation Categories, Barthel Index and Stroke Impact Scale.

Results: MoCA Vis/Ex was significantly associated with baseline activity performance, long-term after stroke (r = .34-.69, p < .05). In the conventional gait training group, MoCA Vis/Ex explained 34% of the variance in 6MWT after the six-week intervention (p = 0.017) and 31% (p = 0.032) at the 6 month follow up, which indicate that a higher MoCA Vis/Ex score enhanced the improvement. The robotic gait training group presented no significant associations between MoCA Vis/Ex and 6MWT indicating that visuospatial/executive function did not affect outcome. Rated executive function (DEX) presented no significant associations to activity performance or outcome after gait training.

Conclusion: Visuospatial/executive function may significantly affect activity performance and the outcome of rehabilitation interventions for impaired mobility long-term after stroke and should be considered in the planning of such interventions. Patients with severely impaired visuospatial/executive function may benefit from robotic gait training since improvement was seen irrespective of visuospatial/executive function. These results may guide future larger studies on interventions targeting long-term walking ability and activity performance.

Place, publisher, year, edition, pages
Public Library of Science , 2023. Vol. 18, no 3, article id e0281212
National Category
Physiotherapy Neurology
Identifiers
URN: urn:nbn:se:umu:diva-205802DOI: 10.1371/journal.pone.0281212ISI: 000949067800050PubMedID: 36893079Scopus ID: 2-s2.0-85149781296OAI: oai:DiVA.org:umu-205802DiVA, id: diva2:1744604
Funder
Swedish Research CouncilRegion StockholmThe Swedish Brain FoundationPromobilia foundationThe Swedish Stroke AssociationAvailable from: 2023-03-20 Created: 2023-03-20 Last updated: 2025-02-11Bibliographically approved

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