Association of affected lower limb flexor muscle strength with swing phase duration and gait speed in elderly post-stroke patients

BACKGROUND: Although several studies have shown an association of muscle weakness with gait speed (GS), no study has explored the relationship of muscle strength with swing phase duration and GS after stroke among the elderly in Saudi Arabia. OBJECTIVE: To examine the association of affected ankle dorsiflexor and hip flexor muscle strength with swing phase duration and GS in the elderly with different stroke chronicity. METHODS: In this cross-sectional study, we included a total of 60 post-stroke patients aged ≥55 years who were admitted in neurorehabilitation units between May 2017 and August 2018. Linear regression was employed to examine the association of muscle strength (measured using a handheld dynamometer) with swing phase duration and GS (both measured using the computerized Zebris–Mat). RESULTS: The chronicity of the stroke was negatively associated (p &lt; 0.05) with swing phase duration. The ankle dorsiflexor muscle strength was significantly associated with GS (β= 0.656, p = 0.041). In contrast, hip flexor muscle strength was significantly associated with GS (β= 0.574, p &lt; 0.0001) even after adjusting for stroke chronicity (β= 0.561, p &lt; 0.0001). CONCLUSIONS: Stroke chronicity was the predictor that reduced swing phase duration. The ankle dorsiflexor muscle strength was associated with GS. However, the hip flexor muscle strength was associated with GS even after adjusting for stroke chronicity.</jats:p

Eating and drinking in later life

Food and drink are vital to life and have a special place in human culture: providing and receiving food has significance beyond sustaining body physiology. Sudden premature death is becoming less common and people experiencing a slow decline before death with frailty and/or dementia is more common. When patients develop swallowing difficulties and disinterest in food and drink, this presents challenges to healthcare workers and families. Should medically assisted (artificial) nutrition and hydration be started? Evidence suggests that it usually makes little or no impact on physical comfort or clinical outcomes but its emotional and cultural role may be great and ethical decision-making must take this into account. In the chapter we discuss various cultural, ethical, and legal perspectives on this situation and the judgements and practical decisions that arise, specifically focusing on those different standpoints from parts of the world where Buddhism, Christianity, Hinduism, Islam, and Judaism are predominant.</p