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• Robotic gait training after botulinum toxin injection improved walking ability. • Robotic gait training improved walking if performed 2 weeks after toxin injection. • Participants walking at 0.4–0.8 m/s benefited most from robotic gait training. Improving walking ability is one of the main goals of rehabilitation after stroke. When lower limb spasticity increases walking difficulty, botulinum toxin type A (BTx-A) injections can be combined with non-pharmacologic interventions such as intensive rehabilitation using a robotic approach. To the best of our knowledge, no comparisons have been made between the efficacy of robotic gait training and conventional physical therapy in combination with BTx-A injections. To conduct a randomized controlled trial to compare the efficacy on gait of robotic gait training versus conventional physiotherapy after BTx-A injection into the spastic triceps surae in people after stroke. Thirty-three participants in the chronic stroke phase with triceps surae spasticity inducing gait impairment were included. After BTx-A injection, participants were randomized into 2 groups. Group A underwent robotic gait training (Lokomat®) for 2 weeks, followed by conventional physiotherapy for 2 weeks (n = 15) and Group B underwent the same treatment in reverse order (n = 18). The efficacy of these methods was tested using the 6-minute walk test (6MWT), comparing post-test 1 and post-test 2 with the pre-test. After the first period, the 6MWT increased significantly more in Group A than in Group B: the mean difference between the interventions was 33 m (95%CI 9; 58 p = 0.007; g = 0.95), in favor of Group A; after the second period, the 6MWT increased in both groups, but the 30 m difference between the groups still remained (95%CI 5; 55 p = 0.019; g = 0.73). Two weeks of robotic gait training performed 2 weeks after BTx-A injections improved walking performance more than conventional physiotherapy. Large-scale studies are now required on the timing of robotic rehabilitation after BTx-A injection. [ABSTRACT FROM AUTHOR]

The control of the center of mass is essential for a stable and efficient gait. Post-stroke patients present several impairments, which may compromise the control of the center of mass during gait in the sagittal and frontal planes. This study aimed to identify changes in the vertical and mediolateral behavior of the center of mass during the single stance phase of post-stroke patients using the statistical parametric mapping analysis. It also aimed to identify alterations in the center of mass trajectories regarding the motor recovery stages. Seventeen stroke patients and 11 neurologically intact individuals were analyzed. The statistical parametric mapping approach was used to identify changes in the center of mass trajectories between stroke and healthy groups. The trajectories of the center of mass of post-stroke individuals were compared according to their motor recovery status. A near-flat vertical trajectory of the center of mass was indenfitifed in the stroke group compared to their healthy counterparts, especially on the paretic side. The center of mass trajectories in both directions (vertical and mediolateral) presented substantial alteration at the end of the single stance phase in the stroke group. The trajectory of the center of mass of the stroke group was symmetrical in the mediolateral direction between the sides. The trajectories of the center of mass presented similar pattern irrespective of the motor recovery status. The statistical parametric mapping approach showed to be suitable for determining gait changes in post-stroke individuals, irrespective of their motor recovery stage. • The center of mass is a stability indicator of gait of post-stroke patients. • The vector analysis can be suitable to identify gait changes in post-stroke patients. • The center of mass may be altered according the motor recovery stages. [ABSTRACT FROM AUTHOR]

Abstract: Background and purpose: The ability to ascend and descend a flight of stairs is considered as one of the best predictors of free-living activity and is correlated with domestic extrinsic activity in hemiparetic patients. However, the relationship between timed-stair performance and clinical and biomechanical parameters has never been studied this population. The aim of this study was to determine if performance on the Timed Up and Down Stairs (TUDS) test was related to clinical variables (maximal gait speed, strength and spasticity) and to biomechanical gait parameters (spatio-temporal, kinematic and kinetic gait parameters) in hemiparetic patients. Methods: Sixty hemiparetic patients performed the TUDS test, underwent 3D gait-analysis and a clinical assessment. Pearson's correlations and two stepwise multiple linear regression analyses were carried out to identify the parameters which were the most highly correlated with TUDS test performance among the clinical variables and gait parameters on the paretic side. Results: Maximal walking speed on the 10-m walk test and strength of the ankle dorsiflexors were the clinical variables that were the most related to TUDS test performance (63% of variance explained). The percentage of single support phase on the paretic side was the biomechanical gait parameter which was the most related to TUDS test performance (58% of variance explained). Conclusion: The results of this study identified three parameters which predicted the performance to ascend and descend a flight of stairs as fast as possible in hemiparetic patients. Rehabilitation programs which aim to improve stair performance and independence in daily life activities should focus on these three parameters. [Copyright &y& Elsevier]

Abstract: The aims of this study were first to further assess the role of the 3D trunk angular rotations as part of the kinematic chain for seated-reaching movements within arm''s length in a large 3D workspace in healthy subjects and second, to assess if these degrees of freedom participate in the compensatory strategy in hemiparetic patients. Ten healthy subjects, eight patients with right, and eight patients with left hemiparesis following stroke were included. They performed seated reaching movements at a comfortable speed to nine targets positioned in a large 3D workspace within arm''s length. An electromagnetic system was used to record kinematics of the trunk and hand. Trunk flexion, lateral flexion and torsion were analyzed as a function of target direction, distance and height. In both healthy subjects and patients, all three trunk rotations participated in the reaching movement (except for near targets in healthy subjects). Trunk flexion was greater in patients but followed a similar pattern to healthy subjects. Trunk torsion was more influenced by target distance in healthy subjects while in patients it was greatly influenced by direction. Trunk lateral flexion was similar between groups. Comparing the two patient groups, there was greater flexion to the external targets in the RHD group and different strategies in the use of torsion between groups. 3D trunk rotations thus seem to be tuned to the distance and direction of the target in the workspace in both healthy subjects and stroke patients for reaching movements within arm''s length. [Copyright &y& Elsevier]

Oxygen delivery and demand are reduced in the paretic leg post-stroke, reflecting decreased vascular function and reduced muscle quantity and quality. However, it is unknown how muscle oxygenation, the balance between muscle oxygen delivery and utilization, is altered in chronic stroke during and after occlusion-induced ischemia.Objectives: The objective was to determine muscle oxygen consumption rate, microvascular responsiveness and reactive hyperemia in the paretic and nonparetic legs during and after arterial occlusion post-stroke.Materials and Methods: Muscle oxygen saturation was measured with near-infrared spectroscopy on the vastus lateralis of each leg during 3-minute arterial occlusion and recovery (3 min). Muscle oxygen consumption was derived from the desaturation slope during ischemia, microvascular responsiveness was derived from the resaturation slope after ischemia and reactive hyperemia was derived from the area under the curve above baseline after ischemia.Results: Eleven subjects (91% male; 32.2±6.1 months post-stroke; age 62.9±13.6 years) with a hemiparetic gait pattern participated. There was no significant between-leg muscle oxygenation difference at rest (paretic: 64.9±16.6%; nonparetic: 70.6±15.6%, p = 0.13). Muscle oxygen consumption in the paretic leg (-0.53±0.24%/s) was significantly reduced compared to the nonparetic leg (-0.70±0.36%/s; p = 0.03). Microvascular responsiveness was significantly reduced in the paretic leg compared to the nonparetic leg (paretic: 4.6±1.8%/s; nonparetic: 5.7±1.6%/s, p = 0.04). Reactive hyperemia was not significantly different between legs (paretic:4384±2341%·s; nonparetic: 3040±2216%·s, p = 0.07).Conclusion: Muscle oxygen consumption and microvascular responsiveness are impaired in the paretic compared to the nonparetic leg, suggesting both reduced skeletal muscle aerobic function and reduced ability to maximally perfuse muscle tissue. [ABSTRACT FROM AUTHOR]

Abstract: Instrumented treadmills offer significant advantages for analysis of human locomotion, including recording consecutive steady-state gait cycles, precisely controlling walking speed, and avoiding force plate targeting. However, some studies of hemiparetic walking on a treadmill have suggested that the moving treadmill belt may fundamentally alter propulsion mechanics. Any differences in propulsion mechanics during treadmill walking would be problematic since recent studies assessing propulsion have provided fundamental insight into hemiparetic walking. The purpose of this study was to test the hypothesis that there would be no difference in the generation of anterior/posterior (A/P) propulsion by performing a carefully controlled comparison of the A/P ground reaction forces (GRFs) and impulses in healthy adults during treadmill and overground walking. Gait data were collected from eight subjects walking overground and on a treadmill with speed and cadence controlled. Peak negative and positive horizontal GRFs in early and late stance, respectively, were reduced by less than 5% of body weight (p<0.05) during treadmill walking compared to overground walking. The magnitude of the braking impulse was similarly lower (p<0.05) during treadmill walking, but no significant difference was found between propulsion impulses. While there were some subtle differences in A/P GRFs between overground and treadmill walking, these results suggest there is no fundamental difference in propulsion mechanics. We conclude that treadmill walking can be used to investigate propulsion generation in healthy and by implication clinical populations. [Copyright &y& Elsevier]

Abstract: Background and purpose: Regaining control of sitting posture is one of the first goals in the rehabilitation of patients with stroke. So, it requires a precise quantification of this postural behaviour. The purpose of the present investigation was thus to assess postural control during sitting in people with hemiparesis through a biomechanical analysis. Methods: Centre-of-pressure displacements were recorded by means of a force platform on which 10 patients with stroke and 10 age-matched healthy subjects were sitting. Centre-of-pressure trajectories were processed through space-time and frequency analyses. Results: These centre-of-pressure displacements of the patients with stroke were characterised by an increased control for maintaining sit position and by reduced postural performance, as enlightened by the larger surfaces covered by the centre-of-pressure displacements (P <.05) and increased velocities (P <.001), respectively. As shown from the frequency analysis, the impairment have affected predominantly the displacements occurring along the antero-posterior axis (P <.05). Interpretations: The analysis of centre-of-pressure displacements during sitting posture indicates an increased postural disturbance in patients with stroke. A platform device, because of the non-invasive, easy and fast measures carried out, should thus be viewed as an attractive tool for assessing the postural dysfunctioning encountered in sat patients with stroke. This tool could also be used for evaluating, the rehabilitation process following stroke. [Copyright &y& Elsevier]

The main purpose of this report is to demonstrate the observation of anterograde Wallerian axonal degeneration (WD) and retrograde neuronal loss to the initial multiple sclerosis (MS) lesion.Longitudinal brain magnetic resonance images (MRI) and single-photon emission computed tomography (SPECT) findings in two relapsing-remitting multiple sclerosis (RR MS) patients are shown.This is an unusual report of long-standing asymptomatic bidirectional progression of the initial lesion. Our data suggest that axonal and neuronal neurodegeneration may occur in the absence of symptoms. [Copyright &y& Elsevier]

Objectives: To study adaptation of anticipatory postural adjustments (APAs) in paretic and non-paretic muscles of individuals with hemiparesis to changes in the direction of the self-initiated perturbation and additional manual support.Methods: Electrical activity of leg and trunk muscles on both sides of the body and ground reaction forces were recorded in 10 patients with hemiparesis and a group of matched control subjects. Subjects released a standard load, held in the hand of the extended relatively unimpaired arm. The load was released either in front of the body or to the side, with or without the impaired arm touching an external stable surface.Results: APAs were reduced in individuals with hemiparesis, especially on the paretic side. In paretic muscles, the modulation of APAs with the direction of the perturbation was decreased or showed atypical patterns. Also the effects of touch were decreased in patients. Center of pressure displacements shortly after load release were similar in control subjects and patients.Conclusions: The results suggest that the ability of individuals with hemiparesis to prepare for a self-initiated predictable perturbation is reduced and that they may use alternative strategies of postural stabilization. [Copyright &y& Elsevier]

Objective: Although studies on the efficacy of the rehabilitation robot are increasing, there are few reports using the robot for gait training in the actual clinical setting. This study aimed to investigate the effectiveness of gait training using Welwalk in hemiparetic stroke patients in a real clinical setting.Materials and Methods: This prospective study included 36 hemiparetic stroke patients who underwent gait training using Welwalk. We examined the walking ability improvement efficiency using Functional Independence Measure (FIM)-walk as the primary outcome, which was compared with that of 36 patients (matched control group) who underwent conventional rehabilitation. Other outcomes were the actual gait training period using Welwalk, raw FIM-walk score, lower extremity motor functions score in Stroke Impairment Assessment Set at discharge, and duration from stroke onset until discharge.Results: The improvement efficiency of the FIM-walk was significantly higher in the Welwalk group than in the matched control group (control 0.48 ± 0.31, Welwalk 0.80 ± 0.38, p-value < 0.001). The mean gait training period using Welwalk was 5 weeks. No significant differences were found in other outcomes between the Welwalk group and the matched control group.Conclusion: This study demonstrated the effectiveness of gait training using Welwalk on the improvement efficiency of the FIM-walk in hemiparetic stroke patients in an actual clinical setting. [ABSTRACT FROM AUTHOR]

The fundamental characteristic of hemiparetic cerebral palsy is the greater motor impairment on the body side that corresponds to the injured cerebral hemisphere. Hemiparesis usually affects the upper limbs, which can provide significant functional disabilities to this population. The objective of this study was to compare alpha and beta band synchronization and desynchronization during the execution of the task in a game, using the limbs paretic and non-paretic. As a result, observed a synchronization of the alpha band for the movement performed by the paretic limb and a desynchronization using the non-paretic limb. This result may indicate less cortical and physical effort to perform the task using the paretic limb. It is believed that this information can stimulate research with a greater number of volunteers and the more thorough study of brain activity in this population. [ABSTRACT FROM AUTHOR]

Introduction/Background Drop foot is the principal ambulatory anomaly impacting hemiplegic patients. The effectiveness of Functional Electric Stimulation (FES) on gait parameters in hemiplegics has been demonstrated over the medium and long term. Clinical evaluation of this setup and its’ effectiveness is not always easy; changes in gait parameters being difficult to measure solely by observation. Ideally, the application of FES should be done along with a 3-D analysis of the patient's gait, which can be a time-consuming procedure. The goal of this study is to evaluate dynamic changes in the center of pressure (COP), measured using an instrumented walkway, when applying FES. Material and method A mono-paretic patient, stable after frontal tumor surgery, was treated with FES of the fibularis communis nerve. The evaluation of gait, at a comfortable walking pace, was realized using an analysis of both spatio-temporal parameters and COP, obtained using the GAITRite walkway. The evaluation was conducted, immediately before and after application of FES. Results Spatio-temporal gait parameters (walking speed, stride length, cadence) were not modified by FES. Our analysis confirms an immediate ‘posteriorization’ of the COP upon initial application of FES. Net postero-anterior displacement of the COP was increased by FES. Conclusion This study confirms the findings in the referenced literature, where during same-day evaluation, FES is shown to not modify spatio-temporal parameters. These modifications only being manifest during prolonged use. We observed changes in the net displacement of the COP on initial application of FES. This corroborates a recent study, which suggests that FES could have an immediate effect on weight transfer and thus increase gait stability. The evaluation of the displacement in the COP could represent a readily observable parameter in gauging the effectiveness of FES when applied to patients with drop-foot. This parameter could be easily and objectively measured with available tools such as an instrumented walkway. [ABSTRACT FROM AUTHOR]