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Pectoralis major injuries are uncommon, typically affecting young male athletes engaging in high-intensity activities like weightlifting. A 62-yr-old man, who previously suffered a stroke leading to left hemiparesis, hemisensory loss, and spasticity, exhibited a left chest swelling during a rehabilitation clinic visit. Subsequent inquiries revealed his recent incorporation of a home-based pulley system for stretching exercises. On examination, the swelling was diffuse, firm, and nontender, located at the midclavicular line of his left chest, with a positive dropped nipple sign and loss of the left anterior axillary fold sign. An ultrasound confirmed a low-grade injury to the left pectoralis major tendon. Spastic muscle ruptures are extremely rare, with only three published reports linked to traumatic brain injury, multiple sclerosis, and spinal cord injury. Spasticity increases muscle vulnerability due to structural and mechanical changes to the skeletal muscles. This is the first report of a spastic pectoralis major tendon rupture and the first after a stroke. This case highlights the need for optimized multimodal spasticity management and reinforces the importance of comprehensive patient education on the safe execution of home-based stretching exercises. [ABSTRACT FROM AUTHOR]

Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days fromonset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional IndependenceMeasure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measurewalk score of 5 (supervision level). The primary outcomewas improvement efficiency of Functional IndependenceMeasure walk, which was the increase in Functional IndependenceMeasure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 (P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported duringWelwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by startingWelwalk training in the early phase after stroke onset. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were (1) to understand the practice patterns and decision-making factors of physical therapists (PTs) when choosing ankle-foot orthoses (AFOs) or functional electrical stimulation (FES) for patients with mobility deficits secondary to poststroke hemiplegia and (2) to explore perceived gaps in knowledge to inform development of a clinical practice guideline (CPG). Methods: A mixed-methods web-based survey collected quantitative and qualitative data from practicing PTs. Descriptive analysis of quantitative data and thematic content analysis of the qualitative data were completed. Results: The 103 PTs were practicing clinicians with a doctoral degree and specialized board certification. A higher level of confidence with AFOs compared with FES was reported, along with increased inclusion of AFOs compared with FES for assessments and treatments. The PTs considered outcomes across the International Classification of Functioning, Disability and Health (ICF) when choosing devices, noting barriers in access and reimbursement as influential factors in clinical decision making. Fewer than 50% participated in continuing education on AFO or FES. Perceived knowledge gaps and educational needs included assessment and intervention strategies to support clinical decision making. The PTs considered themselves influential in the decision-making process and more than 95% of the respondents replied that a CPG on AFO and FES poststroke would impact clinical practice. Conclusion: Themes related to education, clinical decision-making, access, and reimbursement were identified. A CPG may provide valuable information to address gaps in knowledge to improve clinical practice and decision-making. Clinical Relevance: This research aims to inform the development of a CPG to address needs and gaps in knowledge identified by practicing clinicians. The information gained will inform knowledge translation strategies to promote best practices when implementing AFO and FES to improve activity and participation levels of individuals poststroke. [ABSTRACT FROM AUTHOR]

The article focuses on the clinical application of memantine in chronic poststroke aphasia (PSA), highlighting its efficacy alongside constraint-induced aphasia therapy (CIAT). Topics include the patient's history of ischemic stroke, the neurological deficits observed, and the subsequent treatment involving memantine and CIAT.

Introduction: Lumbar lordosis is important for the spine and pelvis to work in harmony in providing trunk control and maintaining sagittal balance. Children with cerebral palsy (CP) have difficulties in providing trunk postural control and balance, which is critical for independence in daily living activities. This study was planned to examine the immediate effect of a lower-trunk orthosis supporting physiological lumbar lordosis on trunk control and upper-limb functionality in children with CP. Objectives and Methods: A total of 30 children with CP, 13 diparetic, 11 hemiparetic, and 6 ataxic, 21 ambulatory (GMFCS I/II), and 9 nonambulatory (GMFCS III/IV) aged 3-16 years were included in the study. The Pediatric Functional Reach Test (PFRT) and the Seated Postural Control Measure (SPCM) were used to assess trunk control; the Pediatric Berg Balance Scale (PBBS) was used to assess balance; and the Box and Block Test (BBT) and the Nine-Hole Peg Test (9HPT) were used to evaluate upper-limb functions. All tests were performed with and without a soft lumbosacral brace. The braces were made of soft, elastic fabric with steel, and weremade by the orthotic technician in four different sizes. The angle of lordosis was adjusted with steel underwires according to each child. The existing physiological lordosis of the child is supported by the brace. It is not intended to increase or decrease. Results: In the study, the results of all evaluations with a brace were better than those without a brace (P < 0.05). No significant difference was found only in the functional part of the SPCM test (P > 0.05). Conclusions: Our study revealed that soft lumbosacral orthosis, which supports physiological lordosis, has a positive effect on trunk stability and upper-limb functionality in children with CP. Clinical Relevance: In children's trunk stability and upper-limb functionality studies, the use of soft lumbosacral orthosis that supports physiological lordosis can be added to rehabilitation programs and daily living activities as a support. [ABSTRACT FROM AUTHOR]

This document is a list of references cited in an article published in the Harvard Review of Psychiatry. The references cover a range of topics related to catatonia in children and adolescents, including its diagnosis, treatment, and underlying neural mechanisms. The references include studies, case series, and guidelines from various countries and perspectives. Some of the topics covered include the use of antipsychotics and electroconvulsive therapy, the genetic basis of catatonia, and the structure of the brain in individuals with catatonia. [Extracted from the article]

Inpatient falls have a significant impact on the outcomes of older patients during inpatient rehabilitation. A retrospective case-control study was conducted using data of 7066 adults aged 55 yrs or older to evaluate significant predictors of inpatient falls during inpatient rehabilitation and the association of inpatient falls with discharge destination and length of stay. A stepwise logistic regression was used to model odds of inpatient falls and home discharge with demographic and clinical characteristic variables and a multivariate linear regression to evaluate the association between inpatient falls and length of stay. Nine hundred thirty-one of 7066 patients (13.18%) had inpatient falls during inpatient rehabilitation. The group with inpatient falls had longer length of stay (14.22 ± 7.82 vs. 11.85 ± 5.33 days, P < 0.0001) and a decreased proportion of home discharges when compared with the group without inpatient falls. There were increased odds of inpatient falls among patients with diagnoses of head injury, other injuries, a history of falls, dementia, a divorced marital status, and a use of laxatives or anticonvulsants. Inpatient falls were associated with an increased length of stay (coefficient = 1.62, confidence interval = 1.19–2.06) and decreased odds of home discharge (odds ratio = 0.79, confidence interval = 0.65–0.96) after inpatient rehabilitation. This knowledge may be incorporated into strategies for reducing inpatient falls during inpatient rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to determine the effects of motor imagery training associated with conventional rehabilitation therapies on lower limb motor function recovery in poststroke patients. Design: Comprehensive literature searches were performed to identify studies published before June 5, 2022. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the Cochrane risk-of-bias tool and the modified Jadad scale. The certainty of the evidence was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations system. Result: Twenty-three trials and/or 1109 participants with motor imagery training ability were included in this review. Motor imagery training combined with conventional rehabilitation therapies versus conventional rehabilitation therapies demonstrated significant benefits in motor function, balance function, temporospatial gait variables (walking speed, stride length, and cadence) and activities of daily living. Subgroup analysis demonstrated that motor imagery training–conventional rehabilitation therapies had a better effect on improvement in motor function and activities of daily living in the acute phase and had a greater benefit on walking speed in the chronic phase. In addition, motor imagery training–conventional rehabilitation therapies resulted in greater improvements in stride length, cadence, walking ability, and balance function in the subacute phase. Conclusions: Motor imagery training–conventional rehabilitation therapies have better effects on the recovery of lower limb motor function in poststroke patients than conventional rehabilitation therapies, which may be most beneficial for lower extremity motor function recovery in the first 7 days to 6 mos. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to investigate the effects of a virtual reality–mediated gamified rehabilitation program on upper limb functions, skills, range of motion, muscle tone, and quality of life in children with hemiplegic cerebral palsy. Design: This prospective, randomized, and controlled study included 36 children with hemiplegic cerebral palsy. Children were randomized into two groups, the virtual reality group (n = 18) and the control group (n = 18). Stretching and range-of-motion exercises were performed on the affected upper limb of the children in both groups. In addition to this exercise program, in the virtual reality group, virtual reality–mediated upper limb rehabilitation was performed under supervision. The children were assessed at baseline and 1 and 3 mos after the intervention. Results: There was a significant increase in Assisting Hand Assessment, ABILHAND-Kids, Quality of Upper Extremity Skills Test, and KINDL values in the virtual reality group. In addition, there were significant increases in the active joint range of motion of the finger flexion, wrist flexion, pronation, and supination in the virtual reality group. Conclusions: In this study, it was determined that upper limb function, quality of life, and active joint range of motion of the children with hemiplegic cerebral palsy were increased with virtual reality–mediated upper limb rehabilitation. [ABSTRACT FROM AUTHOR]

The article provides information about a case study involving a 78-year-old woman who suffered traumatic brain injury resulting in diffuse axonal injury. The study highlights the importance of comprehensive review of neuroimaging to identify potential causes of unexplained findings in patients with traumatic brain injury.

Objective: This study's aims were to refine Music Upper Limb Therapy–Integrated (MULT-I) to create a feasible enriched environment for stroke rehabilitation and compare its biologic and behavioral effects with that of a home exercise program (HEP). Design: This was a randomized mixed-methods study of 30 adults with post-stroke hemiparesis. Serum brain-derived neurotrophic factor and oxytocin levels measured biologic effects, and upper limb function, disability, quality of life, and emotional well-being were assessed as behavioral outcomes. Participant experiences were explored using semistructured interviews. Results: MULT-I participants showed reduced depression from preintervention to postintervention as compared with HEP participants. Brain-derived neurotrophic factor levels significantly increased for MULT-I participants but decreased for HEP participants, with a significant difference between groups after excluding those with post-stroke depression. MULT-I participants additionally improved quality of life and self-perceived physical strength, mobility, activity, participation, and recovery from preintervention to postintervention. HEP participants improved upper limb function. Qualitatively, MULT-I provided psychosocial support and enjoyment, whereas HEP supported self-management of rehabilitation. Conclusions: Implementation of a music-enriched environment is feasible, reduces post-stroke depression, and may enhance the neural environment for recovery via increases in brain-derived neurotrophic factor levels. Self-management of rehabilitation through an HEP may further improve upper limb function. [ABSTRACT FROM AUTHOR]

Study Design: Eight cadavers were included in this anatomical study.Objective: This study aimed to confirm the anatomical feasibility of extradural transfer of the contralateral T11 ventral root (VR) to the ipsilateral L2 level and the contralateral L1 VR to the ipsilateral L3 level to restore lower limb function in cases of paraplegia.Summary Of Background Data: Motor dysfunction due to hemiplegia significantly affects the daily life of patients. To date, unlike in cases of upper limb dysfunction, there are few studies on the surgical management of lower limb movement dysfunction.Materials and Methods: Eight cadavers were included in this study to confirm the feasibility of the nerve transfer. After separating the VR and dorsal root at each level, the VRs at the T11 and L1 levels were anastomosed with the VRs of L2 and L3, respectively. The length of the VRs of donor roots and the distance between the donor and recipient nerves were measured. H&E staining was performed to verify the number of axons and the cross-sectional area of the VRs. Lumbar x-rays of 60 healthy adults were used to measure the distance between the donor and recipient nerves.Results: After exposing the bilateral extradural each root, the VRs could be easily isolated from the whole root. The distance between the VRs of T11 and L2, L1, and L3 was significantly longer than the length of the donor nerve. Therefore, the sural nerve was used for grafting. The measurements performed on the lumbar x-rays of the 60 healthy adults confirmed the results. The number of axons and cross-sectional area of the VRs were measured.Conclusion: Our study confirmed the anatomical feasibility of transferring the VRs of T11 to L2 and that of L1 to L3 to restore lower limb function in cases of hemiplegia.Level Of Evidence: 5. [ABSTRACT FROM AUTHOR]

Study Design: A total of 6 formalin-fixed cadavers were included in the cadaver feasibility study.Objective: The aim was to ascertain the anatomical feasibility of extradural contralateral C7 ventral root transfer technique by cervical posterior.Summary Of Background Data: Upper limb spastic hemiplegia is a common sequela after stroke. In our previous study, the authors established a method by transferring contralateral C7 dorsal and ventral roots to the corresponding C7 dorsal and ventral roots on the affected side in the cervical posterior.Methods: In the present study, six formalin-fixed cadavers were dissected to confirm the anatomical feasibility. Experimental anastomosis in cadavers was conducted. The pertinent lengths of the extradural nerve roots were measured. The tissue structures surrounding regions between the extradural CC7 nerve roots and the vertebral artery were observed. The cervical magnetic resonance imaging scans of 60 adults were used to measure the distance between the donor and recipient nerves.Results: Experimental anastomosis showed that the distance between the donor and recipient nerves was approximately 1 cm; the short segment of the sural nerve needed bridging. The distance between both exit sites of the exit of the extradural dura mater was 33.57±1.55 mm. The length of the extradural CC7 ventral root was 22.00±0.98 mm. The ventral distance (vd) and the dorsal distance (dd) in males were 23.98±1.72 mm and 30.85±2.22 mm ( P <0.05), while those in females were 23.28±1.51 mm and 30.03±2.16 mm, respectively. C7 vertebral transverse process, ligaments, and other soft tissues were observed between the vertebral artery and the extradural C7 nerve root.Conclusion: Under the premise of less trauma, our study shows that the extradural contralateral C7 ventral root transfer technique, in theory, yields better surgical results, including better recovery of motor function and complete preservation of sensory function.Level Of Evidence: 5. [ABSTRACT FROM AUTHOR]

Introduction: Robot-assisted therapy is an innovative approach to upper-limb rehabilitation that uses intensive, repetitive, interactive, and individualized practice as an optimal strategy to enhance motor learning. An example of upper-limb robot-assisted therapy is the myoelectric orthosis MyoPro (Myomo Inc, Cambridge, USA). It is a custom-fabricated myoelectric elbow-wrist-hand orthosis (MEWHO) with built-in surface sensors that detect the user's electromyographic (EMG) signals during muscle contraction. Studies on the MEWHO have focused mostly on elderly chronic stroke patients. None have discussed its use on the adolescent population and the considerations they face in wearing the orthosis. Case Presentation : A 15-year-old male 10th grade student with a diagnosis of right spastic hemiplegia secondary to cerebral palsy was prescribed a MEWHO because of muscle weakness of his right upper extremity, decreased functional status, and fine motor skills deficits. Results : After two occupational therapy cycles, the patient demonstrated improvements in functional strength and performance of physical activities. Despite these improvements, the patient only used the MEWHO during therapy and was less engaged with its use at home and school. Discussion : This case report presents insights on why the patient was not as proficient and interested in using the orthosis at home and school. Recommendations to address these issues include peer modeling, community outings, early intervention, and the use of family-centered approaches. Future studies are also suggested to further understand MEWHO use and the considerations for successful orthotic management in this group of patients. [ABSTRACT FROM AUTHOR]

Objective: Virtual reality technology has begun to be gradually applied to clinical stroke rehabilitation. The study aimed to evaluate the effect of traditional plus virtual reality rehabilitation on motor function recovery, balance, and activities of daily living in stroke patients. Method : Studies published in English before October 2020 were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. This study used RevMan 5.3 software for meta-analysis. Result : A total of 21 randomized controlled trials were included, which enrolled 619 patients. Traditional plus virtual reality rehabilitation is better than traditional rehabilitation in upper limb motor function recovery measured by Fugl-Meyer Assessment-Upper Extremity (mean difference = 3.49, 95% confidence interval = 1.24 to 5.73, P = 0.002) and manual dexterity assessed by Box and Block Test (mean difference = 6.59, 95% confidence interval = 3.45 to 9.74, P < 0.0001). However, there is no significant difference from traditional rehabilitation in activities of daily living assessed by Functional Independence Measure (mean difference = 0.38, 95% confidence interval = -0.26 to 1.02, P = 0.25) and balance assessed by Berg Balance Scale (mean difference = 2.18, 95% confidence interval = -0.35 to 4.71, P = 0.09). Conclusions : Traditional plus virtual reality rehabilitation therapy is an effective method to improve the upper limb motor function and manual dexterity of patients with limb disorders after stroke, and immersive virtual reality rehabilitation treatment may become a new option for rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

We call a hemiparetic hand with paralyzed finger extensors and volitional but spastic flexors a "spastic combination hand." Anecdotally, patients report hand-as-a-holder function with objects like pill bottles, motivating us to formally study spastic combination hand holding capacity using cylinders with different diameters. Nine participants with spastic hemiparesis and spastic combination hand more than 24 mos performed a standardized motor task with 10 cylinder diameters ranging between 1.3 and 9.5 cm and weighing 0.8 and 8.4 oz. Using the unaffected hand, participants attempted to insert a given cylinder into their spastic combination hand, holding it independently for 5 secs. Successful holds were counted during two sessions before and one session after botulinum toxin intervention of Ashworth 3 hand muscles. Findings revealed that a median capacity of six different cylinder diameters was successfully inserted into spastic combination hand at least once before block and a median capacity of 10 cylinders was inserted after block. A mixed-effect statistical model using fixed effects of cylinder diameter and session revealed that total number of successful holds was 43% higher after botulinum. We conclude that this proof-of-concept study does support the idea that spastic combination hand has holding capacity for cylindrical objects of specified diameter and weight and that botulinum neurotoxin offers potential for enlarging spastic combination hand capacity. [ABSTRACT FROM AUTHOR]

Introduction: There are limited examples in the literature of detailed orthotic management related to triplanar control of the ankle-foot complex. The aim of this case report was to describe year-long use of an ankle-foot orthosis-footwear combination (AFO-FC) augmented with a talar flange that aimed to stabilize the subtalar joint during gait in an individual with poststroke hemiplegia who presented with both knee hyperextension and an unstable subtalar joint. Materials and Methods : A 40-year-old woman 1-year poststroke with right hemiplegia presented with right equinovarus and knee hyperextension, with complaint of pain in the ankle and knee. Her right talocrural joint measured 15[degrees] plantarflexion with clinically significant inversion instability. Results : A right solid AFO-FC, designed using published algorithms, was provided. In addition, a talar flange modification was incorporated to control subtalar inversion. During year-long use of the AFO-FC, the patient was able to return to community ambulation without pain. Successful orthotic intervention required that the device met not only biomechanical goals but also broader patient goals, which changed over time. Therapy with the device was also important for successful orthotic intervention. Conclusions: This case illustrates use of a talar flange in an AFO-FC to provide triplanar control of the ankle-foot complex and improve gait in a person poststroke. [ABSTRACT FROM AUTHOR]

Heterotopic ossification is the formation of pathological bone in soft tissues. It is postulated that continuous passive motion is a helpful adjuvant in the halt of the heterotopic ossification progression and the maintenance or increase of the joint mobility. The purpose of this clinical case study is to present the effectiveness of continuous passive motion. A 46-yr-old male patient experiencing right hemiparesis arrived in our rehabilitation department with limitation on passive flexion of the right hip. On x-ray of the pelvis, immature heterotopic bone formation was found. To halt this ongoing process of heterotopic bone formation, a program of continuous passive motion was implemented. In addition, risedronate was administrated. We started the continuous passive motion at 50 degrees of flexion for 30 mins that was increased to 100 degrees for 3 hrs daily. The final range of motion at the hip was: flexion 85 degrees, extension 0 degrees, internal rotation 10 degrees, external rotation 10 degrees, abduction 10 degrees, and adduction 10 degrees. Based on our results, continuous passive motion plays a role in heterotopic ossification maturation. The effectiveness of continuous passive motion implementation against HO should be further investigated for selected cases. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Facial paralysis is a clinical condition associated with significant functional and psychosocial morbidity (Facial Plast Surg FPS. 2011;27(4):346–57). The management paradigm for this condition continues to evolve with the use of both surgical and nonsurgical strategies (Facial Plast Surg FPS. 2011;27(4):346–57). Hypoglossal-facial nerve anastomosis is a surgical technique whereby the hypoglossal nerve acts as a donor motor nerve to restore facial muscle reinnervation via movements of the tongue (Plast Reconstr Surg. 1979;63(1):63–72). This case describes a 33-yr-old woman with unilateral facial paralysis who underwent hypoglossal-facial nerve anastomosis and 14 wks of postoperative rehabilitation. This report highlights the details of her rehabilitation regimen including the specific techniques used to enhance motor relearning of facial expression through movement of the tongue. [ABSTRACT FROM AUTHOR]

Background and Purpose. While the integration of experiential learningwith patients and clients into the physical therapy (PT) curriculum is beneficial to student learning particularly in the area of pediatrics, the implementation of such experiences can be extremely challenging. Telehealth is rapidly expanding given the emerging technology, health care needs for individuals in remote settings, and the current pandemic situation. The purpose of the present evaluation was to examine the perspectives of the students, supervising PTs and the caregiver on a method/ model for the telehealth delivery of pediatric PT, and the collaborative experiential learning experience in this setting using a qualitative grounded theory approach. Method/Model Description. A 24-monthold boy with spastic hemiplegia was treated for 6 weeks in his home via Zoom videoconferencing in a collaborative clinical education experience. Interventions included constraintinduced movement therapy, bimanual training, dynamic balance training, and facilitation of postural control. Caregiver education was provided throughout. The chat and recording features were used throughout each session to provide direction, feedback, and education while minimizing the distraction during sessions. Semi-structured interviews were completed with the 2 PTs, 6 students, and mother after the experience. Interviews were transcribed and theme coded until saturation was achieved. A concept map was developed through consensus. Outcomes themes emerged for telehealth and telehealth learning experiences. Considerations included the home environment, technology, lack of physical contact and importance of verbal communication, preparation, instantaneous feedback, and active participation. The active participation of the caregiver seemed to empower the family and provide them with a therapeutic viewpoint. Communication via the chat feature provided a means for instantaneous feedback that was considered less disruptive to the student--family interaction resulting in student empowerment, confidence, and skill development. Discussion and Conclusion. The telehealth delivery of service seems to enhance the empowerment and buy-in of the patient/ caregiver resulting in improved outcomes and carryover for PT. Telehealth PT experiential learning provides a venue for collaborative learning and enhanced student autonomy resulting in improved confidence while fostering student analytical skills, communication skills, and creativity. Telehealth PTprovides unique opportunities for growth and learning in a collaborative learning experience and may also serve as a venue for clinical education experiences. [ABSTRACT FROM AUTHOR]

An otherwise healthy 21-yr-old female hockey player sustained a cervical whiplash injury during competition after being checked and falling backward onto the ice. Initial assessment revealed right-sided hemiparesis and sensory abnormalities. Magnetic resonance imaging and computed tomography of the brain and spine were unremarkable. Most of her right upper limb symptoms resolved in 24 hrs, with complete resolution in 5 days. Over 6 wks, she regained right lower limb strength with mild residual sensory deficits. Repeat magnetic resonance imaging of the cervical spine was unremarkable. At 18 wks, sensory symptoms resolved, with the exception of mildly decreased lower limb proprioception. The athlete was cleared to return to noncontact drills but not competition. The differential diagnosis included transient quadriplegia and/or hemiplegia ("cervical cord neuropraxia"), which typically resolves in 48 hrs, and incomplete spinal cord injury without radiographic abnormality, which is more likely to present with persistent symptoms. This case includes features of both diagnoses, making management challenging as return to play guidelines are nonspecific. Further research is needed to develop well-defined guidelines for spinal cord injury without radiographic abnormality and cervical cord neuropraxia return-to-play decisions. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy. Design: This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed. Results: The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R 2 = 0.38, P < 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R 2 = 0.15, P < 0.001) and the highest portion of the variance in spatial walking symmetry (R 2 = 0.18, P = 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R 2 = 0.10, P = 0.021). Conclusions: In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Level of ambulation following stroke is a long-term predictor of participation and disability. Decreased lower extremity motor control can impact ambulation and overall mobility. The purpose of this clinical practice guideline (CPG) is to provide evidence to guide clinical decision-making for the use of either ankle-foot orthosis (AFO) or functional electrical stimulation (FES) as an intervention to improve body function and structure, activity, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) for individuals with poststroke hemiplegia with decreased lower extremity motor control. Methods: A review of literature published through November 2019 was performed across 7 databases for all studies involving stroke and AFO or FES. Data extracted included time post-stroke, participant characteristics, device types, outcomes assessed, and intervention parameters. Outcomes were examined upon initial application and after training. Recommendations were determined on the basis of the strength of the evidence and the potential benefits, harm, risks, or costs of providing AFO or FES. Results/Discussion: One-hundred twenty-two meta-analyses, systematic reviews, randomized controlled trials, and cohort studies were included. Strong evidence exists that AFO and FES can each increase gait speed, mobility, and dynamic balance. Moderate evidence exists that AFO and FES increase quality of life, walking endurance, and muscle activation, and weak evidence exists for improving gait kinematics. AFO or FES should not be used to decrease plantarflexor spasticity. Studies that directly compare AFO and FES do not indicate overall superiority of one over the other. But evidence suggests that AFO may lead to more compensatory effects while FES may lead to more therapeutic effects. Due to the potential for gains at any phase post-stroke, the most appropriate device for an individual may change, and reassessments should be completed to ensure the device is meeting the individual's needs. Limitations: This CPG cannot address the effects of one type of AFO over another for the majority of outcomes, as studies used a variety of AFO types and rarely differentiated effects. The recommendations also do not address the severity of hemiparesis, and most studies included participants with varied baseline ambulation ability. Summary: This CPG suggests that AFO and FES both lead to improvements post-stroke. Future studies should examine timing of provision, device types, intervention duration and delivery, longer term follow-up, responders versus nonresponders, and individuals with greater impairments. Disclaimer: These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for people with poststroke hemiplegia who have decreased lower extremity motor control that impacts ambulation and overall mobility. A Video Abstract is available as supplemental digital content from the authors (available at: http://links.lww.com/JNPT/A335). [ABSTRACT FROM AUTHOR]

Introduction: The novel coronavirus disease-19 (COVID-19) has many unique features in its presentation. One increasingly noted symptom is the incidence of hypercoagulability which may lead to ischemic stroke. Physical therapists (PTs) are an integral component of the medical team and contribute to the early identification of stroke-like symptoms in patients with COVID-19. Case Presentation: This case series will describe the rehabilitation process of 3 patients who survived critical illness due to COVID-19 and had secondary complications including right hemiparesis while in critical care. Patients received rehabilitation by PTs and occupational therapists on average 6 times per week with interventions focused on recovery of strength, functional mobility, neurological re-education, and cognition. The mobility status was assessed with the Perme Intensive Care Unit Mobility Score. Conclusion: Patients who present with COVID-19 need careful screening for neurological impairment. Conventional means to diagnose stroke, such as radiological imaging, can be difficult to obtain in these unique circumstances because of infection control measures. Physical therapists can assist in early identification of neurological impairment in the absence of traditional diagnostic methods through identification of deficits in abilities such as mobility and balance. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: The aim of this study was to determine the clinical significance of the anterior-posterior displacement of the center of pressure in the foot (ap CoP) in post-stroke gait rehabilitation. Design: This observational study was conducted in a tertiary hospital. Forty-two subacute post-stroke patients were included. The ap CoP was measured twice with a wearable insole foot pressure measurement system, time interval more than 7 days. The results were compared between the first and second tests. The relationship between ap CoP changes and spatiotemporal parameter changes were investigated. Results: The ap CoP increased significantly between tests. The change in walking speed was significantly predicted by the change in the ap CoP on the less affected side. The change in asymmetry of the single support phase was significantly correlated with the change in the ap CoP on the more affected side. Conclusion: The change in ap CoP provides information about the restoration of body support, body forward progression control, and propulsion in the more affected lower limb during early post-stroke rehabilitation. The ap CoP can be a useful parameter for the monitoring of functional changes in the more affected lower limb during post-stroke gait rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate factors related to paretic upper limb use within the first 4 wks after stroke. Design: Sixty inpatients within 4 wks of first-time stroke were stratified by severity defined by Fugl-Meyer Upper Limb scores: severe = 0-22, moderate = 23-50, and mild = 51-66. All wore a wrist accelerometer on the paretic upper limb (24 hrs). Factors investigated were the following measures: upper limb motor impairment; mobility; balance; functional independence; sensory impairment; cognitive function; social factors; environmental restriction; and knowledge. individual and multivariate quantile regression analyses were performed. Results: Upper limb motor impairment, mobility, balance, functional independence, self-efficacy, and knowing how to use the paretic upper limb were significantly related to upper limb use across the three impairment groups (pseudo R² = 0.079-0.492, P < 0.02). Multivariate regression showed the only significant factor in moderate and mild group was Fugl-Meyer Upper Limb score (moderate pseudo R² = 0.55, mild pseudo R² = 0.54, P < 0.001). For the severe group, Fugl-Meyer upper limb score and step count were significant (severe pseudo R² = 0.47, P ≤ 0.030). Conclusions: Upper limb motor impairment is significantly associated with paretic upper limb use across three impairment groups and step count with the severe group. Strategies to improve upper limb motor impairment and increase mobility may be required to increase upper limb use. [ABSTRACT FROM AUTHOR]

Abstract: Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors report no conflicts of interest.

Supplemental digital content is available in the text. Objective: The aim of this study was to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength and betweenness centrality, induced by a single trial of exoskeleton-assisted gait in chronic stroke survivors. Design: Study design was randomized crossover. Electroencephalographic data (64-channel system) were recorded before gait (baseline) and after unassisted overground walking and overground exoskeleton-assisted walking. Coherence was estimated for alpha1, alpha2, and beta frequency ranges. Graph analysis assessed network model properties: node strength and betweenness centrality. Results: Nine participants were included in the final analysis. In the group (four participants) with a left-hemisphere stroke lesion (dominant hemisphere), over the vertex, node strength increased in alpha1, alpha2, and beta bands, and betweenness centrality decreased in alpha2 both after unassisted overground walking and exoskeleton-assisted walking. In the group (five participants) with a right-hemisphere lesion (nondominant hemisphere), node strength increased in alpha1 and alpha2 over the contralesional sensorimotor area and ipsilesional prefrontal area after overground exoskeleton-assisted walking, compared with baseline and unassisted overground walking. Conclusion: A single session of exoskeleton training provides short-term neuroplastic modulation in chronic stroke. In participants with a nondominant hemisphere lesion, exoskeleton training induces activations similar to those observed in able-bodied participants, suggesting a role of lesion lateralization in networks' reorganization. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: Different methods of neuromuscular electrical stimulation may be used for poststroke upper limb rehabilitation. This study evaluated the effects of contralaterally controlled functional electrical stimulation of the triceps and finger extensors. Design: This is a randomized controlled trial of 67 participants who were less than 2 yrs poststroke and assigned to the following: (a) arm + hand contralaterally controlled functional electrical stimulation, (b) hand contralaterally controlled functional electrical stimulation, or (c) arm + hand cyclic neuromuscular electrical stimulation. Participants were prescribed 10 sessions/week of assigned electrical stimulation at home plus 24 sessions of functional task practice in the laboratory for 12 wks. The primary outcome measure was the Box and Blocks Test. Secondary measures included reachable workspace, Upper Extremity Fugl-Meyer, Stroke Upper Limb Capacity Scale, Arm Motor Abilities Test, and Motor Activity Log. Results: There were no significant between-group differences on the Box and Blocks Test. At 6 mos after treatment, arm + hand contralaterally controlled functional electrical stimulation improved reachable workspace more than hand contralaterally controlled functional electrical stimulation, between-group difference of 264 (95% confidence interval = 28–500) cm2 and more than arm + hand cyclic neuromuscular electrical stimulation, between-group difference of 281 (95% confidence interval = 22–540) cm2. Arm + hand contralaterally controlled functional electrical stimulation improved Upper Extremity Fugl-Meyer score more than hand contralaterally controlled functional electrical stimulation, between-group difference of 6.7 (95% confidence interval = 0.6–12.7). The between-group differences on the Stroke Upper Limb Capacity Scale and Arm Motor Abilities Test were not significant. Conclusions: Adding contralaterally controlled elbow extension to hand contralaterally controlled functional electrical stimulation does not improve on gains in hand dexterity, but it further reduces upper limb impairment and improves reachable workspace measured in the laboratory. However, these additional benefits may not be large enough to be perceived by stroke survivors when they are performing activities of daily living at home. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: A reachable workspace evaluation using the Kinect sensor was previously introduced as a novel upper limb outcome measure in neuromuscular and musculoskeletal conditions. This study investigated its usefulness in hemiplegic stroke patients. Design: Forty-one patients with hemiplegic stroke were included. Kinect-based reachable workspace analysis was performed on both paretic and nonparetic sides. Upper limb impairment was measured using the Fugl-Meyer Assessment and the Motricity Index on the paretic side. Disability was assessed using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. Correlations between the relative surface areas, impairment scores, and disability were analyzed. Results: Quadrants 1, 3, and 4 as well as the total relative surface area of the paretic side were significantly reduced compared with the nonparetic side. The total relative surface area of the paretic side correlated with the Fugl-Meyer Assessment scores, the Motricity Index for Upper Extremity, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Furthermore, quadrant 3 was the most important determinant of upper limb impairment and disability. Conclusions: A reachable workspace (a sensor-based measure that can be obtained relatively quickly and unobtrusively) could be a useful and alternative outcome measure for upper limb in hemiplegic stroke patients. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Functional electrical stimulation therapy (FEST) is a state-of-the-art treatment for retraining motor function after neurological injuries. Recent literature suggests that FEST can be further improved with brain-computer interface (BCI) technology. In this case study, we assessed the feasibility of using BCI-triggered FEST (BCI-FEST) to restore upper limb function in a 57-yr-old man with severe left hemiplegia resulting from a stroke 6 yrs before enrollment in the study. The intervention consisted of two blocks of forty 1-hr BCI-FEST sessions, with three sessions delivered weekly. During therapy, a single-channel BCI was used to trigger the stimulation programmed to facilitate functional movements. The measure of the feasibility of the BCI-FEST included assessing the implementation and safety of the intervention. Clinical improvements were assessed using (a) Functional Independence Measure, (b) Action Research Arm Test, (c) Toronto Rehabilitation Institute – Hand Function Test, and (d) Fugl-Meyer Assessment Upper Extremity test. Upon completion of 80 therapy sessions, 14-, 17-, and 18-point changes were recorded on Action Research Arm Test, Fugl-Meyer Assessment Upper Extremity test, and Toronto Rehabilitation Institute – Hand Function Test, respectively. The participant also indicated improvement as demonstrated by his ability to perform various day-to-day tasks. The results suggest that BCI-FEST is safe and viable. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Objective: A systematic review and meta-analysis were conducted to determine the efficacy of repetitive transcranial magnetic stimulation in recovering motor function in patients with stroke. Design: A comprehensive literature search was performed to identify studies published before September 20, 2018. Electronic databases were searched. Standard mean differences and 95% confidence intervals were used to evaluate the effects of repetitive transcranial magnetic stimulation. The stability and sensitivity of the results and sources of heterogeneity were also analyzed. The Cochrane Risk of Bias Tool was used to determine the quality of the studies. Result: Twenty randomized controlled trials (N = 841 patients) were included. The results showed that repetitive transcranial magnetic stimulation is beneficial to patients with poststroke hemiplegia, as demonstrated by the following four scales: the Fugl-Meyer Assessment (standard mean difference = 0.635, 95% confidence interval = 0.421 to 0.848); grip strength (standard mean difference = 1.147, 95% confidence interval = 0.761 to 1.534); Barthel Index (Standard mean difference = 0.580, 95% confidence interval = 0.377 to 0.783); and National Institutes of Health Stroke Scale (standard mean difference = −0.555, 95% confidence interval = −0.813 to −0.298). Few adverse events were observed. Conclusions: The analysis showed that low-frequency repetitive transcranial magnetic stimulation has a positive effect on grip strength and lower limb function as assessed by FMA. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. The role and function that proprioception plays in movement and motor learning have been debated since the 19th century but can be difficult to isolate and study. Lesions at various points along the proprioceptive pathway result in afferent paresis that can be significantly disabling. Compensatory mechanisms can help with successful rehabilitation and provide an opportunity to study the role of these mechanisms in sensory feedback. Here, we present two cases of adult patients with complete hemisensory loss after a stroke: one patient with a cortical stroke and the other one with a thalamic stroke. First, we see that that motor learning can occur without proprioception, with the help of visual feedback. Second, proprioception plays an important role in movement: in the upper limb, it can facilitate individual finger movements, and in the lower limb, it maintains sufficient knee flexion to prevent the knee from going into recurvatum (backward bending) during ambulation. [ABSTRACT FROM AUTHOR]

We present a novel case of new-onset, polyarticular tophaceous gout, which developed on the patient's hemiparetic side several days after she was diagnosed with a middle cerebral artery stroke. This is the first case of an acute gout flare in a patient without history of gout. She was successfully treated with anakinra. [ABSTRACT FROM AUTHOR]

A case study of 21-yr-old woman is presented with recent diagnosis of pseudotumor cerebri that was admitted to a community hospital with rapidly progressive left hemiplegia and worsening headache. Topics include examines the magnetic resonance imaging revealed demyelinating lesions suspicious for neuromyelitis optica vs. multiple sclerosis (MS).

Impairments in ankle joint position sense along with muscle weakness greatly affect the recovery of balance among stroke survivors. Elastic therapeutic taping has been studied in musculoskeletal conditions of the ankle to improve joint position sense and its effects in stroke are not known. The aims of the study were to investigate the differences in joint position sense between paretic and nonparetic ankles and to examine the effects of elastic therapeutic taping on joint position sense of the paretic ankle in stroke survivors. Sixteen chronic stroke survivors participated in a 2-day protocol of ankle elastic therapeutic taping on the paretic side. Active and passive joint position sense at the ankle was measured by Biodex Isokinetic III system on both the paretic and nonparetic sides before elastic therapeutic taping and only the paretic side after elastic therapeutic taping. The active and passive ankle joint position sense values were significantly (P < 0.001) lower on the paretic side than the nonparetic side before intervention. Joint position sense significantly (P < 0.001) improved for the paretic ankle after elastic therapeutic taping. Chronic stroke survivors were deficient in ankle joint position sense on the paretic side. Elastic therapeutic taping was effective in the short term to improve active and passive joint position sense. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to examine the feasibility of immersive virtual reality mirror therapy for upper limb paresis after stroke using a head-mounted display and provide preliminary evidence of efficacy. Design: Ten outpatients with chronic stroke, upper limb hemiparesis, and a low predisposition for motion sickness completed a 12-session program of 30 mins each of immersive virtual reality mirror therapy. The virtual reality system provided the illusion of movement in the hemiparetic upper limb while suppressing the visual representation of the nonparetic side. Feasibility was assessed via patient compliance, adverse event tracking, the System Usability Scale, and the Simulator Sickness Questionnaire. Preliminary efficacy was evaluated using the Fugl-Meyer Upper Extremity and Action Research Arm Test. Results: Immersive virtual realitymirror therapy for patientswith chronic strokewas safe, well-tolerated, and without adverse events, such as sim- ulator sickness.Motor outcomes revealed a small improvement for the Fugl-MeyerUpper Extremity from21.7 (SD= 8.68) to 22.8 (SD= 9.19) that did not achieve statistical significance (P = 0.084). Conclusions: Four weeks of immersive virtual reality mirror therapy was well-tolerated by chronic stroke patients. Our findings support further clinical trials of immersive virtual reality technologies and visually enhanced mirror therapies for stroke survivors. [ABSTRACT FROM AUTHOR]

Objective: The contribution of the contralesional motor cortex to the impaired limbs is still controversial. The aim of this study was to investigate the role of descending projections from the contralesional hemisphere during voluntary elbow flexion on the paretic side. Design: Eleven healthy and 10 stroke subjects performed unilateral isometric elbow flexion tasks at various submaximal levels. Transcranialmagnetic stimulation was delivered to the hotspot of bicepsmuscles ipsilateral to the target side (paretic side in stroke subjects or right side in controls) at rest and during elbow flexion tasks. Motor-evoked potential amplitudes of the contralateral resting biceps muscles, transcranial magnetic stimulation--induced ipsilateral force increment, and reflex torque and weakness of spastic elbow flexors were quantified. Results: The normalized motor-evoked potential amplitude increased with force level in both healthy and stroke subjects. However, stroke subjects exhibited significantly higher force increment compared with healthy subjects only at low level of elbow flexion but similar at moderate to high levels. The greater force increment significantly correlated with reflex torque of the spastic elbow flexors, but not weakness. Conclusions: These results provide novel evidence that ipsilateral projections are not likely to contribute to strength but are correlated to spasticity of spastic-paretic elbow flexors after stroke. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate the association between body mass index and rehabilitation outcome in hemiparetic patients with stroke in subacute phase. Design: This was a prospective study testing the correlation between body mass index and the effectiveness of rehabilitation, measured using Barthel Index scores.We enrolled patients with subacute stroke (n = 664; age, 68 ± 14 yrs; length of hospital stay, 84 ± 34 days).We assessed the body mass index and Barthel Index both at admission and discharge. The effectiveness of rehabilitation was computed as the percentage increment in Barthel Index score with respect to the maximum achievable improvement. Results: Effectiveness of rehabilitation was significantly correlated with the body mass index at discharge (R = 0.111, P = 0.004) and percentage change in body mass index (R = 0.253, P < 0.001), but not with body mass index at admission (R = 0.006, P = 0.869). Conclusions: In addition to body mass index value, our findings suggest that rehabilitation outcomes can be influenced by the change in body mass index during rehabilitation. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine the effect of electrical stimulation in the treatment of hemiplegic shoulder pain. Design: Eight databases were systematically searched for randomized controlled trials with a treatment duration of at least 2 wks comparing electrical stimulation with sham stimulation or no stimulation for patients with hemiplegic shoulder pain. Shoulder pain on the hemiplegic side after stroke at baseline was required at study selection. The overall effects of electrical stimulation were calculated using a meta-analytic method. Results: Six studies were included. The pooled data indicated that electrical stimulation may have a positive effect for patients with hemiplegic shoulder pain on pain reduction (n = 193, standardized mean difference = -1.89, 95% confidence interval = -3.05 to -0.74) and pain-free external rotation (n = 164, weighted mean difference = 18.92, 95% confidence interval = 7.00 to 30.84). Meta-analysis also showed better recovery of activities of daily living independence in patient groups receiving electrical stimulation (n = 167, weighted mean difference = 8.96, 95% confidence interval = 5.26 to 12.66). Conclusions: Electrical stimulation may be an effective pain management methodology for hemiplegic shoulders and may contribute to pain-free range of external rotation as well as activities of daily living recovery. However, these results should be interpreted with caution, given the low number of selected studies and risk of potential bias. [ABSTRACT FROM AUTHOR]

Introduction: The primary aim of this preliminary prospective cross-sectional study was to assess the effects of Lycra arm sleeves on the glenohumeral subluxation (acromiongreater tuberosity distance) in people with poststroke hemiplegia. A secondary aim was to explore patients' perceptions regarding the practicality of applying the Lycra arm sleeve. The setting was community care in South West England. Participants were patients with chronic stroke (n = 5; 2 men, 3 women; mean ± SD age, 51 ± 8 years) with one-sided weakness. Materials and Methods: Patients were instructed to wear the Lycra arm sleeve for 7 hrs a day for 7 consecutive days. Ultrasound measurements of acromion greater tuberosity (AGT) distance, numerical rating scale for pain, and upper-limb function using the Motor Assessment Scale were recorded before and immediately after application of the sleeve on day 1 and day 8. A questionnaire was completed by patients on day 8 to explore perceptions. Results: Analysis of the data using an analysis of variance for a 2 × 2 fully repeated measure design suggests that 1) there is no significant mean difference in AGT distance between day 1 and day 8 (F (1,4) = 1.28, MSE = 0.014, P = 0.322) 2); there is a significant mean difference in AGT distance due to wearing of sleeve (F (1,4) = 19.258, MSE = 0.011, P = 0.012); and 3) the change in AGT distance on day 1 due to wearing of sleeve is not statistically different from the change on day 8 (F (1,4) = 0.537, MSE = 0.008, P = 0.504). Three patients experienced decreased pain, and one patient showed improvement in the upper-limb function score. The mean time the Lycra arm sleeve was worn each day was 6.7 hrs. Three patients found the sleeve easy to wear and 4 patients found the sleeve beneficial. Conclusions: Trends toward reduction in mean AGT distance suggest Lycra arm sleeves may be beneficial in glenohumeral subluxation (GHS) management. Further research is required to establish their effectiveness in acute and chronic settings using a well-designed fully powered randomized controlled trial. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to determine whether somatosensory stimulation affects outcomes of motor training for moderate-to-severe upper limb hemiparesis less than 12 mos before stroke. Design: Fifty-five adults participated in 18 intervention sessions pairing 2 hours of active (n = 33) or sham (n = 22) somatosensory stimulation with 4 hours of intensive task-oriented motor training. Wolf Motor Function Test, Action Research Arm Test, Fugl-Meyer Assessment, and Stroke Impact Scale were administered at baseline, postintervention, and 1- and 4-mo follow-up. Results: Statistically significant between-groups differences favored the active condition on Wolf Motor Function Test at post (P = 0.04) and Action Research Arm Test at post (P = 0.02), 1 mo (P = 0.01), and 4 mos (P = 0.01) but favored the sham condition on Stroke Impact Scale at 1 mo (P = 0.03). There were no significant between-groups differences on Fugl-Meyer Assessment. Conclusions: Somatosensory stimulation can improve objective outcomes of motor training for moderate-to-severe hemiparesis less than 12 mos after stroke, although it needs to be determined whether the magnitude of between-groups differences in this study is clinically relevant. Future studies should investigate the intervention's impact on disability and functional recovery for this population as well as neurophysiological mechanisms underlying intervention effects. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the effectiveness of mirror therapy on recovery in the severely impaired arm after stroke. Design: Using single-blind randomized controlled design, patients with severely impaired arm within 1-month post-stroke were assigned to receive mirror therapy (n = 20) or control therapy (n = 21), 30 mins twice daily for 4 wks in addition to conventional rehabilitation. During mirror therapy and control therapy, subjects practiced similar structured exercises in both arms, except that mirror reflection of the unaffected arm was the visual feedback for mirror therapy, but mirror was absent for control therapy so that subjects could watch both arms in exercise. Fugl-Meyer Assessment and Wolf Motor Function Test were the outcome measurements. Results: After the intervention, both mirror therapy and control therapy groups had significant arm recovery similarly in Fugl-Meyer Assessment (P = 0.867), Wolf Motor Function Test-Time (P = 0.947) and Wolf Motor Function Test-Functional Ability Scale (P = 0.676). Conclusion: Mirror therapy or control therapy, which involved exercises concurrently for the paretic and unaffected arms during subacute stroke, promoted similar motor recovery in the severely impaired arm. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to examine the effect of cane use and cane positions on the sit-to-stand performance of stroke patients. Design: In a crossover study, 30 stroke patients performed sit-to-stand test in seven situations in a random sequence: without a cane, three positions with a regular cane (parallel to the ankle, parallel to the 5th toe, and 10 cm in front of the 5th toe), and the same three positions with a quad cane. The peak vertical ground reaction force and maximum vertical cane support force during sit-to-stand were recorded. Results: Using a cane significantly reduced the peak ground reaction force by 3% to 9% of body weight compared with that without a cane (P = 0.000-0.023). Different cane positions strongly influenced the maximum cane support force and peak ground reaction force. When the cane was closer to the ankle, the maximal cane support force increased by 6.7% to 8.6% of body weight, which resulted in a decrease in the peak ground reaction force. Conclusions: Both types of cane reduced lower limbs' load during sit to stand. When the cane was closer to the trunk, the load on legs was lessened, whereas the load on the upper limb increased. Upper limb's load during sit to stand was greater when using quad cane than using regular cane. [ABSTRACT FROM AUTHOR]

Background: The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower limbs after stroke have been insufficiently studied. Objective: The aim of the study was to evaluate the effect of priming with 1-Hz repetitive transcranial magnetic stimulation over contralesional leg motor area with a double-cone coil before physical therapy on regaining ambulation. Methods: Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental group or control group to receive a 15-min real or sham 1-Hz repetitive transcranial magnetic stimulation, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min physical therapy for 15 sessions for 3 wks. Functional measures, motor evoked potentials, and quality of life were assessed. Results: There was no significant difference between experimental group and control group regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only the control group displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention. Conclusions: The present study found that insufficient evidence that contralesional priming with 1-Hz repetitive transcranial magnetic stimulation improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke. [ABSTRACT FROM AUTHOR]

Purpose: After a cerebrovascular accident (CVA) aerobic deconditioning contributes to diminished physical function. Functional electrical stimulation (FES)--assisted cycling is a promising exercise paradigm designed to target both aerobic capacity and locomotor function. This pilot study aimed to evaluate the effects of an FES--assisted cycling intervention on aerobic capacity and locomotor function in individuals post-CVA. Methods: Eleven individuals with chronic (96 months) post-CVA hemiparesis completed an 8-wk (three times per week; 24 sessions) progressive FES-assisted cycling intervention. ...O2peak, self-selected, and fastest comfortable walking speeds, gait, and pedaling symmetry, 6-min walk test (6MWT), balance, dynamic gait movements, and health status were measured at baseline and posttraining. Results: Functional electrical stimulation-assisted cycling significantly improved ...O2peak (12%, P = 0.006), self-selected walking speed (SSWS, 0.05 ± 0.1 m⋅s-1, P = 0.04), Activities-specific Balance Confidence scale score (12.75 ± 17.4, P = 0.04), Berg Balance Scale score (3.91 ± 4.2, P = 0.016), Dynamic Gait Index score (1.64 ± 1.4, P = 0.016), and Stroke Impact Scale participation/ role domain score (12.74 ± 16.7, P = 0.027). Additionally, pedal symmetry, represented by the paretic limb contribution to pedaling (paretic pedaling ratio [PPR]) significantly improved (10.09% ± 9.0%, P = 0.016). Although step length symmetry (paretic step ratio [PSR]) did improve, these changes were not statistically significant (-0.05% ± 0.1%, P = 0.09). Exploratory correlations showed moderate association between change in SSWS and 6-min walk test (r = 0.74), and moderate/strong negative association between change in PPR and PSR. Conclusions: These results support FES-assisted cycling as a means to improve both aerobic capacity and locomotor function. Improvements in SSWS, balance, dynamic walking movements, and participation in familial and societal roles are important targets for rehabilitation of individuals after CVA. Interestingly, the correlation between PSR and PPR suggests that improvements in pedaling symmetry may translate to a more symmetric gait pattern. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the efficacy of Armeo robotic therapy, compared with conventional therapy, on upper limb function in children with hemiplegic cerebral palsy. Design: Thirty children with hemiplegic cerebral palsy, with ages ranging from 6 to 8 yrs, were selected for this randomized controlled study and randomly assigned to two groups. The study group (n = 15) received 12 wks of Armeo robotic therapy (45 min/session, 3 days/wk) and the control group (n = 15) received conventional therapy for the same period. The measured outcomes were the Modified Ashworth Scale and the Quality of Upper Extremity Skills Test, measured at baseline and after 12 wks of intervention. Results: Children in the study group showed significant improvement in themean values of all the measured variables, comparedwith those in the control group (P < 0.05). Postintervention Modified Ashworth Scale scores for the study and control groupswere 1.6 (0.3) and 2 (0.5), respectively. Postinterventional Quality of Upper Extremity Skills Test total scores for the study and control groups were 84.6 (2.7) and 79.1 (2), respectively. Conclusions: Armeo robotic therapy is significantly more effective than conventional therapy in improving the upper limb quality ofmovement in children with hemiplegic cerebral palsy. [ABSTRACT FROM AUTHOR]

A correct assessment of cardiopulmonary capacity is important for aerobic training within motor rehabilitation of poststroke hemiparetic patients (PSHPs). However, specific cardiopulmonary exercise testing (CPET) for these patients are scarce. We proposed adaptations in a protocol originally developed for PSHPs by Ovando et al. (CPET1). We hypothesized that our adapted protocol (CPET2) would improve the original test, by preventing early fatigue and increasing patients' peak performance. Eleven PSHPs (52 ± 14 years, 10 men) performed both protocols. CPET2 integrated changes in final speed (100--120% vs. 140% maximal speed in 10-m walking test), treadmill inclination (final inclination of 5 vs. 10%), and estimated test duration (10 vs. 8 minutes) to smooth the rate of workload increment of CPET1. Peak oxygen uptake ...O2peak) (20.3 ± 6.1 vs. 18.6 ± 5.0 ml•kg-1•min-1; p = 0.04), ...O2 at gas exchange transition ...O2-GET) (11.5 ± 2.9 vs. 9.8 ± 2.0 ml•kg-1•min-1; p = 0.04), and time to exhaustion (10 ± 3 vs. 6 ± 2 minutes; p < 0.001) were higher in CPET2 than in CPET1. Slopes and intercepts of regressions describing relationships between ...O2 vs. workload, heart rate vs. workload, and ...O2 vs. heart rate were similar between CPETs. However, standard errors of estimates obtained for regressions between heart rate vs. workload (3.0 ± 1.3 vs. 3.8 ± 1.0 b•min-1; p = 0.004) and ...O2 vs. heart rate (6.0 ± 2.1 vs. 4.8 ± 2.4 ml•kg-1•min-1; p = 0.05) were lower in CPET2 than in CPET1. In conclusion, the present adaptations in Ovando's CPET protocol increased exercise tolerance of PSHPs, eliciting higher ...O2peak and ...O2-GET, preventing earlier fatigue, and providing better physiological relationships along submaximal workloads. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the effects on common poststroke gait compensations of a soft wearable robot (exosuit) designed to assist the paretic limb during hemiparetic walking. Design: A single-session study of eight individuals in the chronic phase of stroke recovery was conducted. Two testing conditions were compared: walking with the exosuit powered versus walking with the exosuit unpowered. Each condition was 8 minutes in duration. Results: Compared with walking with the exosuit unpowered, walking with the exosuit powered resulted in reductions in hip hiking (27[6%], P = 0.004) and circumduction (20[5%], P = 0.004). A relationship between changes in knee flexion and changes in hip hiking was observed (Pearson r = -0.913,P<0.001). Similarly, multivariate regression revealed that changes in knee flexion (β = -0.912,P=0.007), but not ankle dorsiflexion (β = -0.194, P = 0.341), independently predicted changes in hip hiking (R² = 0.87, F(2, 4) = 13.48, P = 0.017). Conclusions: Exosuit assistance of the paretic limb during walking produces immediate changes in the kinematic strategy used to advance the paretic limb. Future work is necessary to determine how exosuit-induced reductions in paretic hip hiking and circumduction during gait training could be leveraged to facilitate more normal walking behavior during unassisted walking. [ABSTRACT FROM AUTHOR]