Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

Objective: The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program. Methods: Thirty-one post-stroke patients (60.6 +/- 12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (F-ext, F-flex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test. Results: The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of nonparetic limbs. At baseline examination muscle strength difference between both F-flex kg(-1) and F-ext kg(-1) had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fext kg(-1) and, interestingly, even more prominent for F-flex kg(-1). Conclusions: MMEP can effectively increase muscle strength and functional capacity in poststroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors. (C) 2017 Polish Neurological Society. Published by Elsevier Sp. z o.o. All rights reserved.