title: Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation.
abstract: 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 (Fext, Fflex) 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 non-paretic limbs. At baseline examination muscle strength difference between both Fflexkg-1and Fextkg-1had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fextkg-1and, interestingly, even more prominent for Fflexkg-1.
  
  
  CONCLUSIONS
  MMEP can effectively increase muscle strength and functional capacity in post-stroke 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.
authors.affiliation: Department of Physical Medicine, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland. Electronic address: joanna.kostka@umed.lodz.pl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kostka
authors.affiliation: Faculty of Pedagogy and Health Promotion, College of Informatics and Skills of Lodz, Ul. Rzgowska 17 a, 93-008 Lodz, Poland. Electronic address: jan.czernicki@umed.lodz.pl.
authors.forename: Jan
authors.initials: J
authors.lastname: Czernicki
authors.affiliation: Clinical Department of Post Traumatic Rehabilitation, Medical University of Lodz, Ul. Pieniny 30, 92-115 Lodz, Poland. Electronic address: magdalena.pruszynska@umed.lodz.pl.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pruszyńska
authors.affiliation: Department of Physical Medicine, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland. Electronic address: elzbieta.dorota.miller@umed.lodz.pl.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Miller
mesh_terms: D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010243:Paralysis / Q000503:physiopathology* / Q000534:rehabilitation*; D011379:Prognosis; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: Functional performance; Multi-modal exercise program; Muscle strength