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Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity.

ABSTRACT: BACKGROUND AND PURPOSE:Poststroke hemiparesis increases the perceived challenge of walking. Perceived challenge is commonly measured by self-report, which is susceptible to measurement bias. A promising approach to objectively assess perceived challenge is measuring sympathetic nervous system (SNS) activity with skin conductance to detect the physiological stress response. We investigated the feasibility of using skin conductance measurements to detect task-related differences in the challenge posed by complex walking tasks in adults poststroke. METHODS:Adults poststroke (n = 31) and healthy young adults (n = 8) performed walking tasks including typical walking, walking in dim lighting, walking over obstacles, and dual-task walking. Measures of skin conductance and spatiotemporal gait parameters were recorded. Continuous decomposition analysis was conducted to assess changes in skin conductance level (?SCL) and skin conductance response (?SCR). A subset of participants poststroke also underwent a 12-week rehabilitation intervention. RESULTS:SNS activity measured by skin conductance (both ?SCL and ?SCR) was significantly greater for the obstacles task and dual-task walking than for typical walking in the stroke group. Participants also exhibited "cautious" gait behaviors of slower speed, shorter step length, and wider step width during the challenging tasks. Following the rehabilitation intervention, SNS activity decreased significantly for the obstacles task and dual-task walking. DISCUSSION AND CONCLUSIONS:SNS activity measured by skin conductance is a feasible approach for quantifying task-related differences in the perceived challenge of walking tasks in people poststroke. Furthermore, reduced SNS activity during walking following a rehabilitation intervention suggests a beneficial reduction in the physiological stress response evoked by complex walking tasks.Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A234).

SUBMITTER: Chatterjee SA

PROVIDER: S-EPMC6156783 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity.

Chatterjee Sudeshna A SA Daly Janis J JJ Porges Eric C EC Fox Emily J EJ Rose Dorian K DK McGuirk Theresa E TE Otzel Dana M DM Butera Katie A KA Clark David J DJ

Journal of neurologic physical therapy : JNPT 20181001 4

<h4>Background and purpose</h4>Poststroke hemiparesis increases the perceived challenge of walking. Perceived challenge is commonly measured by self-report, which is susceptible to measurement bias. A promising approach to objectively assess perceived challenge is measuring sympathetic nervous system (SNS) activity with skin conductance to detect the physiological stress response. We investigated the feasibility of using skin conductance measurements to detect task-related differences in the cha ...[more]

PMID: 30138228

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Project description:BackgroundImpairments in central and/or peripheral nervous systems are known to be associated with altered gait; however, the interplay between cognitive function, peripheral sensation, and orbital gait stability remains largely unclear. Elucidating these relationships is expected to provide a clearer understanding of potential fall risk factors across various populations and targets for novel interventions. Many patients diagnosed with cancer are treated with chemotherapy agents known to be neurotoxic to the central and/or peripheral nervous systems that can contribute to movement deficiencies, making this population a novel model to investigate these relationships.Research questionThe purpose of this exploratory study was to investigate how central and peripheral nervous system impairments associate with orbital stability during single- and dual-task gait.MethodsTwenty cancer survivors were enrolled and separated into three groups: no prior chemotherapy exposure (CON, n = 6), and prior treatment with chemotherapy and having no/mild chemotherapy-induced peripheral neuropathy (CIPN) symptoms (-CIPN, n = 8) or moderate/severe CIPN symptoms (+CIPN, n = 6). Testing included single- and dual-task (i.e., serial sevens) treadmill walking as well as a computerized test of executive function. Maximum Floquet multipliers were calculated to assess orbital stability during gait.ResultsWorse executive function was associated with decreased orbital stability during the dual-task condition in the +CIPN group (Spearman's ρ = 0.94, P = 0.017). Additionally, decreased orbital stability during dual-task gait was observed for the -CIPN group compared to the CON group (ES = 1.96, P = 0.019).SignificanceExecutive dysfunction was associated with decreased gait stability during challenging dual-task gait in survivors with sensory symptoms of CIPN. The association between combined central and peripheral nervous system impairments and decreased gait stability in cancer survivors provides a novel demonstration of potential compensatory strategies that accompany deficiencies in these functions. Future work is needed to confirm these relationships and whether they hold in other populations.

Dataset Information

Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity.

Publications

Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity.

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