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AbstractPurposeMethodResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo evaluate the effectiveness of school-based physiotherapy interventions for improving students’ participation in school settings.A systematic review was reported using PRISMA guidelines. Four databases were searched for studies investigating physiotherapy outcomes of school-based physiotherapy interventions in children. Studies were categorised by intervention type and evaluated based on evidence level and conduct.Fifteen intervention types (23 studies) met criteria. Strong positive evidence supported treadmill training without bodyweight support (n = 1), and upper limb interventions (n = 2). Moderate positive evidence supported robotic-assisted gait training (n = 1), Gross Motor Activity Training with Multimodal Education-Based Therapy (GMAT + MET) (n = 2), neurodevelopmental treatment (n = 2), and rock climbing (n = 1). Weak positive evidence supported environmental modifications (n = 1), Ergonomic Health Literacy (n = 3), GMAT (n = 1), GMAT with progressive resistance exercise (GMAT-PRE) (n = 1), hippotherapy (n = 1), MET alone (n = 7), overground gait training (n = 2), treadmill training with partial body-weight support (n = 1), and non-immersive virtual reality (n = 3).There is preliminary supporting evidence for a variety of school-based physiotherapy interventions which is consistent with evidence for interventions with established efficacy in other contexts. The evidence for interventions in school contexts alone is insufficient to guide current practice. Future research should specifically evaluate the effectiveness of physiotherapy approaches in school settings.Preliminary supporting evidence exists for a variety of school-based physiotherapy interventions, primarily those with established efficacy in other contexts.Successful interventions were designed with a direct focus on assisting participants to improve their ability to engage in school activities.Relevant participation-focussed outcome measures should be used to evaluate the effectiveness of intervention provided in a school context.Interventions with proven effectiveness for specific population groups in other contexts are likely to be effective in schools, however the impact on participation at school is yet to be determined.Preliminary supporting evidence exists for a variety of school-based physiotherapy interventions, primarily those with established efficacy in other contexts.Successful interventions were designed with a direct focus on assisting participants to improve their ability to engage in school activities.Relevant participation-focussed outcome measures should be used to evaluate the effectiveness of intervention provided in a school context.Interventions with proven effectiveness for specific population groups in other contexts are likely to be effective in schools, however the impact on participation at school is yet to be determined. [ABSTRACT FROM AUTHOR]

The current study aimed to evaluate the effects of action observation on the walking ability and oscillatory brain activity of chronic stroke patients. Fourteen chronic stroke patients were allocated randomly to the action observation (AO) or sham observation (SO) groups. Both groups received 12 sessions of intervention. Each session composed of 12 min of observational training, which depicted exercises for the experimental group but nature pictures for the sham group and 40 min of occupational therapy, which was the same for the both groups. Walking ability was assessed by a motion analysis system and brain activity was monitored using quantitative electroencephalography (QEEG) before and after the intervention. Brain asymmetry at alpha frequency, the percentage of stance phase, and step length showed significant changes in the AO group. Only the change in global alpha power was significantly correlated with the change in velocity after the intervention in AO group. Despite more improvements in walking and brain activity of patients in the AO group, our study failed to show significant correlations between the brain activity changes and functional improvements after the intervention, which might be mainly due to the small sample size in our study. Trial registration: IRCT20181014041333N1 [ABSTRACT FROM AUTHOR]

Purpose: To describe the pathophysiology, importance of multimodal imaging approach, and the clinical outcomes of incomplete lacerating rectus muscle injuries. Methods: A retrospective review was conducted to identify patients with ocular deviation secondary to rectus muscle injuries. Between 2019 and 2022, a total of 30 patients were identified, amongst whom eleven patients had incompletely lacerated rectus muscles (secondary to penetrating adnexal trauma and sino-orbital surgeries). Patients’ demography, nature of injury, computed tomography/magnetic resonance imaging, anterior segment optical coherence tomography features, intra-operative findings, and post-operative outcomes were reviewed. Results: The mean age of 11 patients was 31.36 ± 14.38 years. All patients had external trauma which severed the muscle in its anterior portion. Five patients had isolated inferior rectus muscle injury (45.45%), three had inferior and medial rectus muscle injuries together (27.27%), two had isolated lateral rectus muscle injury (18.18%), and one remaining patient had isolated medial rectus muscle injury (9.05%). In ten patients (90.90%) CT/MRI revealed features suggestive of muscle injury, however details with respect to muscle insertion and scleral course were lacking. In this difficult scenario, ASOCT filled these lacunae in nearly 90% of the patients by providing surgically useful details. Moreover, when CT/MRI-ASOCT imaging features were combined, the management and outcomes were even more predictable. Conclusions: Penetrating rectus muscle injuries can be better identified as incompletely lacerated muscle using multimodal imaging approach. This simple image correlation process customizes the treatment approach and hence the clinical outcomes. [ABSTRACT FROM AUTHOR]

Inadequate trunk function is the underlying cause of many problems such as impaired balance and mobility. Although there have been trunk-based physiotherapy approaches in recent years, almost all of these approaches focus on motor problems. This study aims to investigate the effects of sensory training combined with trunk-centered Bobath exercises on trunk control and proprioception, balance, gait, and the activity of daily living (ADL). This study is a randomized controlled trial included with twenty-seven stroke patients. Participants were separated into two groups, Group 1; 'sensory training combined with trunk-centered Bobath exercises' and Group 2; 'trunk-centered Bobath exercises'. Trunk-centered Bobath exercises were used for motor training. Sensory training included transcutaneous electric nerve stimulation and a set of exercises that provide tactile and proprioceptive stimulation. Trunk Impairment Scale, Trunk Reposition Error, Berg Balance Scale, 2-minute walk test, and Barthel Index were used to assess trunk control, trunk proprioception, balance, gait, and ADL respectively. Intra-group analysis results showed that trunk control, trunk proprioception, balance, gait, and ADL improved in both groups after treatment (p < 0.05). The changes in the Trunk Reposition Error values of the participants in Group 1 before and after treatment was found to be significantly higher than Group 2 (p < 0.05). The findings indicated that the application of trunk-centered motor training is effective in improving trunk proprioception and trunk control, balance, gait, and ADL in stroke patients. Also, sensory training combined with trunk-centered motor training was found more effective in improving trunk proprioception than solely motor training. [ABSTRACT FROM AUTHOR]

Treadmills are important rehabilitation tools used with or without handrails. The handrails could be used to attain balance, prevent falls, and improve the walking biomechanics of stroke survivors, but it is yet unclear how the treadmill handrails impact their stability margins. Here, we investigated how 3 treadmill handrail-use conditions (no-hold, self-selected support, and light touch) impact stroke survivors' margins of stability (MoS). The anteroposterior MoS significantly increased for both legs with self-selected support while the mediolateral MoS of the unaffected leg decreased significantly when the participants walked with self-selected support in comparison to no-hold in both cases. We concluded that the contextual use of the handrail should guide its prescription for fall prevention or balance training in rehabilitation programs. [ABSTRACT FROM AUTHOR]

The 8-figure shoulder brace during treadmill training (8-FSBTT) intervention can stabilize the shoulder joint, improve the upright of the thoracic spine, induces a change in the angle of the arm during walking, and consequently improve walking ability in stroke patients. Our objective is to compare the effects of a 4-week program of 8-FSBTT with those of only treadmill training (OT) on arm swing angle, and gait parameters (gait speed, cadence, and both side stride lengths) in chronic stroke patients. Participants were randomized to either the 8-FSBTT (n = 11) or OT (n = 11) group. Patients in both groups underwent standard physiotherapy for 30 min per session. In addition, 8-FSBTT and OT interventions were performed 10 min, 5 times per week for 4 weeks. Arm swing angle, gait speed, cadence, and both side stride lengths were measured after 4 weeks of training. After 4 weeks of training, the 8-FSBTT group showed significant improvement in all outcome measures compared with baseline (p < 0.05). Furthermore, Arm swing angle, gait speed, cadence, and both side stride lengths showed greater improvement in the 8-FSBTT group compared to the OT group (p < 0.05). This study demonstrated that 8-FSBTT training, combined with standard physiotherapy, improved Arm swing angle, gait speed, cadence, and both side stride lengths in the chronic stroke patients. [ABSTRACT FROM AUTHOR]

To determine the effect of baseline cognition on gait outcomes after a treadmill training program for people with Parkinson's disease (PD). This pilot clinical trial involved people with PD who were classified as having no cognitive impairment (PD-NCI) or mild cognitive impairment (PD-MCI). Baseline executive function and memory were assessed. The intervention was a 10-week gait training program (twice-weekly treadmill sessions), with structured speed and distance progression and verbal cues for gait quality. Response to intervention was assessed by gait speed measured after week 2 (short-term) and week 10 (long-term). Participants (n = 19; 12 PD-NCI, 7 PD-MCI) had a mean (standard deviation) age of 66.5 (6.3) years, disease duration of 8.8 (6.3) years, and MDS-UPDRS III score of 21.3 (10.7). Gait speed increased at short-term and long-term assessments. The response did not differ between PD-NCI and PD-MCI groups; however, better baseline memory performance and milder PD motor severity were independently associated with greater improvements in gait speed in unadjusted and adjusted models. These findings suggest that memory impairments and more severe motor involvement can influence the response to gait rehabilitation in PD and highlight the need for treatments optimized for people with greater cognitive and motor impairment. Cognitive deficits in Parkinson's disease (PD) could impact motor learning and gait rehabilitation, yet little is known about the effects of cognitive impairments on the response to rehabilitation in people with PD. This study demonstrates that the response to gait rehabilitation did not differ between people with PD who had no cognitive impairment and those with mild cognitive impairment. Across all participants, better baseline memory was associated with greater improvements in gait speed. Rehabilitation professionals should be mindful of PD severity, as those with more substantial memory and motor impairments may require additional dosing or support to maximize gait training benefits. [ABSTRACT FROM AUTHOR]

Patients with mild-to-moderate hip OA can present with pain, a decline in function, altered gait mechanics, and pain with ambulation. Body weight supported treadmill training (BWSTT) has been utilized for patients with total hip arthroplasty, hip fracture, and lumbar spinal stenosis. The purpose of this case series was to report the outcomes of patients with hip OA that received guideline adherent physical therapy care with the addition of BWSTT. Our aim was to assess changes in pain, disability, and physical performance. Seven patients participated in eight 1-h treatment sessions consisting of: manual therapy, therapeutic exercise, and BWSTT. Pre- and post-treatment outcome measures included: average pain rating via the Numeric Pain Rating Scale (NPRS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Global Rate of Change (GROC). Physical performance measures included: 6-minute walk test (6MWT), stair climbing test, and 5 time sit-stand. The mean improvement in NPRS score for all subjects was 2.9 points. Mean improvement on the WOMAC was 18.5 + 24.8 pts, and the mean GROC score was +5.0 indicating a rating of "quite a bit better." The mean increase in 6MWT distance was 60.5 + 80.1 meters (median 39 m, range −3 to 230). Though patients participating in a multimodal rehabilitation approach including manual therapy, exercise, and BWSTT demonstrated clinically important improvements in pain and function, these changes may not correspond with gait endurance improvements in the short term. [ABSTRACT FROM AUTHOR]

Individuals who sustain a traumatic spinal cord injury (SCI) often have a loss of multiple body systems. Significant functional improvement can be gained by individual SCI through the use of neuroprostheses based on electrical stimulation. The most common actions produced are grasp, overhead reach, trunk posture, standing, stepping, bladder/bowel/sexual function, and respiratory functions. We review the fundamental principles of electrical stimulation, which are established, allowing stimulation to be safely delivered through implanted devices for many decades. We review four common clinical applications for SCI, including grasp/reach, standing/stepping, bladder/bowel function, and respiratory functions. Systems used to implement these functions have many common features, but are also customized based on the functional goals of each approach. Further, neuroprosthetic systems are customized based on the needs of each user. The results to date show that implanted neuroprostheses can have a significant impact on the health, function, and quality of life for individuals with SCI. A key focus for the future is to make implanted neuroprostheses broadly available to the SCI population. [ABSTRACT FROM AUTHOR]

Data about postoperative infections in male adults with spinal cord injury are scarce. We aimed to evaluate the association between prior exposure to pressure ulcers (PU) and the risk of postoperative infections in male adults with spinal cord injury (SCI). We conducted a prospective study of male adults receiving surgery of SCI from January 2007 to December 2019. Postoperative infection included septicemia, pneumonia, surgical incision infection and urinary tract infection. A logistic regression analysis was applied. Risk ratios (RRs) and their corresponding 95% confidence intervals (CIs) were calculated. There were 408 patients with SCI in this study, which comprised 204 patients with prior PU and 204 patients without. The rate of postoperative infections within 14 days in patients with PU was 23.5%, which was higher than that of patients without PU (6.9%). The amounts to a 4.18-folds elevated risk of any postoperative infections with 14 days in patients with PU (RR: 4.18, 95% CI: 2.30–7.60, p-value: <0.001). With respect to specific infections, positive associations in pneumonia (RR: 4.18, 95% CI: 2.30–7.60, p-value: <0.001), surgical incision infection (RR: 4.18, 95% CI: 2.30–7.60, p-value: <0.001), and urinary tract infection (RR: 4.18, 95% CI: 2.30–7.60, p-value: <0.001) were also statistically significant. These results did not materially alter adjustment for potential risk factors. The study suggests an elevated risk of postoperative infections after surgery for SCI in male patients with prior exposure to pressure ulcers. [ABSTRACT FROM AUTHOR]

In this paper, we conducted a meta-analysis on the curcumin effect on functional recovery provided by the Basso, Beattie, Brenham (BBB) test for rats, and the Basso mouse scale (BMS) for mice after spinal cord injury (SCI) in animal models. Data mining was performed, and the standard mean difference (SMD) between the treated and control (untreated) groups was calculated using the STATA software. Quality control and subgroup analysis were performed. The analysis includes 24 experimental studies that showed curcumin had a strong significance in improving functional recovery after SCI (SMD = 3.38; 95% CI: 2.54–4.22; p < 0.001). When curcumin was administered daily, it had a stronger effect than single-dose treatment or weekly administration. Despite the same effect in the follow-up time before and after 4 weeks post-injury, but later 9 weeks, curcumin had only a moderate effect. Curcumin also significantly reduced the expression of GFAP (Glial fibrillary acidic protein) marker compared to untreated groups. These findings suggest that daily administration of curcumin can be an effective approach to improving functional recovery after SCI. [ABSTRACT FROM AUTHOR]

Progressive supranuclear palsy (PSP) is a neurodegenerative condition, typically presenting with, but not limited to, impairments of postural instability, gait, and gaze stability. This case report describes the multifactorial assessment and rehabilitation of a patient with atypical PSP who has significant gaze deficits, asymmetrical stepping responses, trunk rigidity, and reduced posterior excursion on limits of stability. Evaluation utilized computerized gait and balance assessments, foot clearance analysis, a squat test, and a timed stepping test. The intervention included boxing, stepping tasks, and treadmill training each with eye movement challenges. A total of 15 hours of physical therapy was provided; 1 hour, 2 times a week. Post-intervention improvements were noted subjectively, on eye-body coordination, and objectively, on limits of stability, foot clearance, and task performance (squats, timed stepping). Follow-up demonstrated some decline from posttest results; however, patient-reported adherence to the program was less than recommended. A multifactorial rehabilitation program can improve balance, eye-body coordination, and strength in a high functioning patient with atypical PSP. Longitudinal randomized controlled studies are suggested to further investigate this interventional approach in high functioning individuals diagnosed with atypical PSP. [ABSTRACT FROM AUTHOR]

To explore the reliability of percentage of Body Weight Support (BWS) needed for maximal pain relief and of pain scores across 12 walking conditions including pre and post-over-ground walking and an unweighting protocol from 0% to 40% BWS on a lower body positive pressure (LBPP) treadmill for individuals with knee osteoarthritis (OA). Twenty individuals (64 ± 9.44 years) with knee OA completed over-ground walking and an unweighting protocol on an LBPP treadmill. The amount of BWS started at 0% and increased by 5% increments until it reached 40%. Pain scores were recorded at the end of each increment. The reliability of pain scores was assessed using a Spearman's rho. This study found moderate reliability of the percentage of BWS for maximal pain relief. Additionally, there was good reliability of pain scores with pre and post-over-ground walking and from 0% BWS to 30% BWS, but moderate reliability of pain scores was found at 35% and 40% BWS. This study supports the use of pain scores as a reliable measure during an unweighted walking session on an LBPP treadmill. Both the OARSI and ACR recommend exercise in the treatment of individuals with knee OA but acknowledge that pain during exercise and exercise preference/accessibility are important when considering the type of exercise for an individual. LBPP treadmills decrease pain in individuals with knee OA during walking. Pain scores during unweighted walking show moderate to good reliability for individuals with knee OA. This study provides an unweighting protocol to use clinically to determine the Body Weight Support needed to decrease pain. [ABSTRACT FROM AUTHOR]

Body mass index, pain, female sex, and age have been reported as predictors of physical activity in patients with lumbar spinal stenosis (LSS). However, no reports have examined the psychological factors associated with physical activity in people with LSS. To use psychological assessments to identify the factors associated with physical activity measured as daily step count in people with LSS. Seventy-one patients who received outpatient physical therapy were included. All patients completed the following scales at baseline: Zurich Claudication Questionnaire; self-paced walking test (SPWT); numerical rating scale of low back pain, leg pain, and leg numbness; Hospital Anxiety and Depression Scale (HADS); Pain Catastrophizing Scale; Pain Anxiety Symptoms Scale (PASS-20); and Tampa Scale for Kinesiophobia. Physical activity was measured using a pedometer as the average number of daily steps. Daily step count was significantly associated with age, number of stenoses, severity of stenosis at L3–L4, walking distance on the SPWT, PASS-20 total score, cognitive anxiety, escape/avoidance, fear, and HADS depression score (p <.05). Multiple regression analysis showed that age, severity of stenosis at L3–L4, walking distance on the SPWT, and PASS-20 fear predicted daily step count (r2 = 0.414). Older age, fewer stenoses, less severe stenosis at L3–L4, lower walking capacity, higher anxiety, and fear-avoidance beliefs about pain and depression are more closely associated with lower daily step count than are back and leg pain. Assessment and treatment of psychological factors might help to increase physical activity in patients with LSS. [ABSTRACT FROM AUTHOR]

Our report describes the effect of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-supported treadmill training (BWSTT) on independent gait recovery in a patient with incomplete spinal cord injury (iSCI). The patient was a 31-year-old male, household ambulator (aid walker) and community wheelchair user who was 8.5 year post traumatic iSCI (T8 vertebra injury, AIS D). The patient participated in 12 sessions (three times/week for four weeks) of rTMS (1800 pulses, 10 Hz, intensity of 90% resting motor threshold) followed by BWSTT (15–20 min, moderate intensity). After treatment, the patient's score increased 3 points on the Walking Index for Spinal Cord Injury II (walking independence) and he became a community ambulator with crutches. His American Spinal Injury Association (ASIA) lower extremities motor score (motor function) increased from 33 to 45 points and the Spinal Cord Independence Measure III (functional independence) score increased from 23 to 29 for the mobility indoors/outdoors subscale. The patient's lower limb spasticity was reduced (Modified Ashworth Scale), and quality of life improved based on the Short-Form Health Survey – 36, and the Patient Global Impression of Change Scale showed considerable perception of improvement. Our report suggests that a short protocol of rTMS combined with BWSTT improved walking independence, motor function, spasticity, functional mobility and quality of life in this patient with iSCI. [ABSTRACT FROM AUTHOR]

There is growing awareness of the need for mathematics and computing to quantitatively understand the complex dynamics and feedbacks in the life sciences. Although several institutions and research groups are conducting pioneering multidisciplinary research, communication and education across fields remain a bottleneck. The opportunity is ripe for using education research-supported mechanisms of cross-disciplinary training at the intersection of mathematics, computation, and biology. This case study uses the computational apprenticeship theoretical framework to describe the efforts of a computational biology lab to rapidly prototype, test, and refine a mentorship infrastructure for undergraduate research experiences. We describe the challenges, benefits, and lessons learned, as well as the utility of the computational apprenticeship framework in supporting computational/math students learning and contributing to biology, and biologists in learning computational methods. We also explore implications for undergraduate classroom instruction and cross-disciplinary scientific communication. [ABSTRACT FROM AUTHOR]

Outlet constipation is a major problem in spinal cord injury (SCI) patients. We aimed to study the efficacy of external anal sphincter (EAS) infiltration with type-A botulinum toxin (BTX-A) in motor incomplete SCI patients with outlet constipation. Double blind, randomized, placebo controlled, comparative study in 16 motor incomplete SCI subjects. Patients were randomly assigned toreceive100 UI of BTX-A (n = 9) or physiologic serum infiltration (n = 7) in the EAS under electromyographic guidance. Outcome measures included a questionnaire for clinical bowel function evaluation, colonic transit time and anorectal manometry. All assessments were done at baseline, 1 and 3 months after treatment. Fourteen patients completed the study. In the BTX-A group we observed an improvement of subjective perception of bowel function (p = 0.01), constipation (p = 0.02) and neurogenic bowel dysfunction score (p = 0.02). The anorectal manometry revealed are duction of EAS voluntary contraction pressure (p = 0.01). No changes were observed in the placebo group. No significant side effects were observed in none of the groups. BTX-A infiltration of the EAS is a safe technique that in motor incomplete SCI, decreases the EAS contraction and the anal canal pressure during straining, and improves outlet constipation symptoms. Future studies in larger populations are needed. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine the tibiofemoral forces during functional electrical stimulation (FES) rowing in individuals with spinal cord injury (SCI). We analysed the motion of five participants with SCI during FES rowing, with simultaneous measurements of (i) three-dimensional marker trajectories, (ii) foot reaction forces (FRFs), (iii) ergometer handle forces, and (iv) timestamps for electrical stimulation of the quadriceps and hamstrings muscles. We created full-body musculoskeletal models in OpenSim to determine subject-specific tibiofemoral forces during FES rowing. The peak magnitudes of tibiofemoral forces averaged over five participants with SCI were 2.43 ± 0.39 BW and 2.25 ± 0.71 BW for the left and right legs, respectively. The peak magnitudes of FRFs were 0.19 ± 0.04 BW in each leg. The peak magnitude of handle forces was 0.47 ± 0.19 BW. Peak tibiofemoral force was associated with peak FRF (magnitudes, R2 = 0.56, p = 0.013) and peak handle force (magnitudes, R2 = 0.54, p = 0.016). The ratios of peak magnitude of tibiofemoral force to peak magnitude of FRF were 12.9 ± 1.9 (left) and 11.6 ± 2.4 (right), and to peak magnitude of handle force were 5.7 ± 2.3 (left) and 4.9 ± 0.9 (right). This work lays the foundation for developing a direct exercise intensity metric for bone mechanical stimulus at the knee during rehabilitation exercises. Clinical Significance: Knowledge of tibiofemoral forces from exercises such as FES rowing may provide clinicians the ability to personalize rehabilitation protocols to ensure that an SCI patient is receiving the minimum dose of mechanical stimulus necessary to maintain bone health. [ABSTRACT FROM AUTHOR]

Purpose: The Lokomat is a commercially available robotic gait trainer, applied for gait rehabilitation in post-stroke hemiparetic patients. Selective and well-dosed clinical use of the Lokomat training parameters, i.e. guidance, speed and bodyweight support, requires a good understanding of how these parameters affect the neuromuscular control of post-stroke hemiparetic gait. Materials and methods: Ten stroke patients (unilateral paresis, 7 females, 64.5 ± 6.4 years, >3months post-stroke, FAC scores 2–4)) walked in the Lokomat under varying parameter settings: 50% or 100% guidance, 0.28 or 0.56m/s, 0% or 50% bodyweight support. Electromyography was recorded bilaterally from Gluteus Medius, Biceps Femoris, Vastus Lateralis, Medial Gastrocnemius, and Tibialis Anterior. Pressure sensors placed under the feet were used to determine the level of temporal gait symmetry. Results: Varying guidance and bodyweight support had little effect on muscle activity, but increasing treadmill speed led to increased activity in both the affected (Biceps Femoris, Medial Gastrocnemius, Tibialis Anterior) and unaffected leg (all muscles). The level of temporal symmetry was unaffected by the parameter settings. Conclusions: The Lokomat training parameters are generally ineffective in shaping short term muscle activity and step symmetry patients with hemiparetic stroke, as speed is the only parameter that significantly affects muscular amplitude. Trial Registration: d.n.a. The Lokomat is a commercially available gait trainer that can be used for gait rehabilitation in post-stroke hemiparetic patients. This study shows that muscle amplitude is generally low during Lokomat guided walking, and that treadmill Speed is the main training parameter to influence muscular output in stroke patients during Lokomat walking. Varying Guidance and Bodyweight Support within a clinical relevant range barely affected muscle activity, and temporal step symmetry was unaffected by variation in any of the training parameters. Based on the findings it is advised to increase speed as early as possible during Lokomat therapy, or use other means (e.g. feedback or instructions) to stimulate active involvement of patients during training. [ABSTRACT FROM AUTHOR]

Gait recognition is one measure of biometrics, which also includes facial, fingerprint, and retina recognition. Although most biometric methods require direct contact between a device and a subject, gait recognition has unique characteristics whereby interaction with the subjects is not required and can be performed from a distance. Cameras are commonly used for gait recognition, and a number of researchers have used depth information obtained using an RGB-D camera, such as the Microsoft Kinect. Although depth-based gait recognition has advantages, such as robustness against light conditions or appearance variations, there are also limitations. For instance, the RGB-D camera cannot be used outdoors and the measurement distance is limited to approximately 10 meters. The present paper describes a long short-term memory-based method for gait recognition using a real-time multi-line LiDAR. Very few studies have dealt with LiDAR-based gait recognition, and the present study is the first attempt that combines LiDAR data and long short-term memory for gait recognition and focuses on dealing with different appearances. We collect the first gait recognition dataset that consists of time-series range data for 30 people with clothing variations and show the effectiveness of the proposed approach. [ABSTRACT FROM AUTHOR]

This study investigated whether physiological demand or gait mechanics differ between sexes during treadmill load carriage. Female (n = 15) and male (n = 15) military recruit-type participants with no load carriage experience completed three 10-minute walking trials at a self-selected speed with increasing relative body-borne loads (0%, 20%, and 40% body weight). A range of cardiorespiratory, perceptual and biomechanical variables were measured. Self-selected walking speed was similar between sexes (4.6–4.8 km·h−1, p >.05) and there were no significant sex-by-load interactions for any variables. Absolute V O2 and V CO2 were greater in males (difference 175–178 mL·min−1, p <.001), however, when relative to body mass, V O2 was similar between sexes (p >.05). Across all loads, cadence was 7 ± 2 steps·min−1 faster (p =.004) and stance time was 0.06 ± 0.02 s shorter (p =.013) in females. Increasing load resulted in greater physiological demand, cadence, % stance time, and step length (p <.05). Practitioner summary: Literature comparing physiological and biomechanical variables between sexes during load carriage is scarce. Physiological and biomechanical sex differences were limited to relative measures associated with physical size (height and mass). Future research may pool male and female participants when conducting trials up to ten minutes in length. Abbreviations: BW: body weight; COM: centre of mass; HR: heart rate; HRmax: maximum heart rate; RER: respiratory exchange ratio; RPE: rating of perceived exertion; VCO2: volume of carbon dioxide; VE: ventilation; VO2: volume of oxygen; VO2max: maximum volume of oxygen [ABSTRACT FROM AUTHOR]

During pulmonary rehabilitation, a subset of subjects with COPD requires adjunct therapy to achieve high-intensity training. Both noninvasive ventilation (NIV) and inspiratory muscle training (IMT) are available to assist these subjects. We aimed to prime the respiratory muscles before NIV with IMT, anticipating additive effects for maximal exercise tolerance (Tlim) and dyspnea/leg fatigue relief throughout the exercise as primary outcomes. Changes in the respiratory pattern were secondary outcomes. COPD subjects performed a total of four identical constant work rate tests on a cycle ergometer at 75% of maximum work rate, under control ventilation (SHAM, 4 cm H2O) or proportional assisted ventilation (PAV, individually adjusted), before and after 10 sessions of high-intensity IMT (three times/week) during 30 days. Two-way RM ANOVA with appropriate corrections were performed. Final analysis in nine subjects showed improved Tlim (Δ = 111 s) and lower minute-ventilation (Δ = 4 L.min−1) at exhaustion, when comparing the IMT effects within the PAV modality (p = 0.001 and p = 0.036, respectively) and improved Tlim for PAV vs. SHAM (PAV main-effect, p = 0.001; IMT main-effect, p = 0.006; PAV vs. IMT interaction, p = 0.034). In addition, IMT + PAV association, compared to PAV alone, resulted in lower respiratory frequency (IMT main-effect, p = 0.009; time main-effect, p < 0.0001; IMT vs. time interaction, p = 0.242) and lower inspiratory time related to duty cycle (IMT main-effect, p = 0.018; time main-effect, p = 0.0001; IMT vs. time interaction, p = 0.004) throughout exercise. The addition of IMT prior to a PAV-supported aerobic bout potentiates exercise tolerance and dyspnea relief and induces favourable changes in ventilatory pattern in severe COPD during high-intensity training (Brazilian Registry of Clinical Trials, number RBR-6n3dzz). [ABSTRACT FROM AUTHOR]

West Nile virus (WNV) can have severe consequences, including encephalitis and paralysis. Purpose: To describe the benefits of intensive locomotor training (LT) for an individual with a previous WNV infection resulting in chronic paraplegia. Case Description: The patient, who became a wheelchair user following standard rehabilitation, began LT 3 years post infection. Her goals included standing and walking with an assistive device and transferring independently. The intervention consisted of bodyweight-supported treadmill training and overground training, which involved walking, balancing, strengthening, and transferring activities. Outcomes: Following 5 months of LT, the patient ambulated independently with a walker at a speed = 0.34m/s. She walked 110.1 metres in 6 minutes and increased her Berg Balance Scale score by 17 points. These improvements were either maintained or further increased 3 months post LT. The patient's perspectives on LT were collected through a semi-structured interview. A conventional content analysis, which uses data to drive themes, revealed three themes: (1) recalibrating goals, (2) outcomes (i.e. physical and psychological benefits, such as a sense of accomplishment), and (3) challenges of LT and effective coping strategies. Conclusions: The patient demonstrated improved balance and walking abilities. Intensive LT was feasible and effective for this individual with chronic paraplegia due to WNV infection. [ABSTRACT FROM AUTHOR]

There are diverse forms of rehabilitative techniques available to improve postural control in diabetic peripheral neuropathy but little is known about the efficacy of these techniques. The primary focus of this review is to find out the effectiveness of diverse rehabilitative interventions in improving postural control in type 2 induced diabetic peripheral neuropathy. Methods: Two reviewers independently scrutinized the included studies. The selected studies underwent quality assessment by PEDro scale. Randomized Controlled Trial (RCT) having a score of 4 or more were included in the review. A search was conducted in PUBMED, MEDLINE, CINAHL, EMBASE, PROQUEST, Science Direct, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Google Scholar. The Medical Subject Headings (MeSH) related to the interventions were also taken into account. Results: A total of 563 studies were identified and finally 8 studies were included in the review process. The included studies were 3 in task-specific balance training, 1 in treadmill, 1 in strengthening, 2 in whole body vibration, and 1 study in pilates analyzing posture using static posturography. No RCTs were reportedly found under tai chi and yoga. Conclusions: Interventions related to task-specific approach in balance training, treadmill, strengthening, WBV showed improvement in static postural control. Intervention with pilates did not show any beneficial effects. However, there still remains a need for quality trials as the results of these studies were ambivalent in interpretation and quality of the studies were limited by small sample size and higher attrition rates. [ABSTRACT FROM AUTHOR]

Millions of people around the globe have to deal with walking disability. Robotic walk assist devices can help people with walking disabilities, especially those with weak legs. However, safety, cost, efficiency and user friendliness are some of the key challenges. For robotic walk assist devices, light weight structure and energy efficient design as well as optimal control are vitally important. In addition, compliance control can help to improve the safety of such devices as well as contribute to their user friendliness. In this paper, an optimal adaptive compliance control is proposed for a Robotic walk assist device. The suggested scheme is based on bio-inspired reinforcement learning. It is completely dynamic-model-free scheme and employs joint position and velocity feedback as well as sensed joint torque (applied by user during walk) for compliance control. The efficiency of the controller is tested in simulation on a robotic walk assisting device model. [ABSTRACT FROM AUTHOR]

In order to understand the effect of an intervention to promote safety or to prevent traumatic injury, an experimental study design is preferred over an observational study design. Since interventions are administered to groups, there is less control over who actually receives the intervention; and adherence to the intervention is more difficult to monitor in group settings. However, the choice of intervention study design is usually dictated by pragmatic and practical reasons, as well as by the types of interventions to be undertaken. [Extracted from the article]

Attempts at weight control are common in university students. Two of the most commonly cited methods of weight control are dieting and exercise. The purpose of this study was to assess if different dieting identities/motives predicted exercise goals, motivations, and frequency/intensity of exercise in undergraduate women. Participants were 117 women from a large university in the United States. Participants completed a set of empirically supported questionnaires inquiring about dieting identity (weight loss, weight maintenance, or non-dieting), exercise frequency and intensity, exercise goals (e.g. health vs. weight loss), and exercise motivations. Women were also asked to self-identify as dieting to lose weight, dieting to maintain weight, or not dieting. Non-dieters and women dieting for weight loss were more likely to engage in exercise for extrinsic and aesthetic reasons. Women dieting for weight maintenance were more likely to report intrinsic goals and motivation for exercise. Consistent with previous work, weight loss as a goal was associated with unhealthy dieting and exercise participation. Individuals dieting for weight loss are at increased risk for discontinuing exercise. Health benefits, and not weight loss, should be emphasised for exercise interventions for undergraduates. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of a body weight supported treadmill training (BWSTT) intervention on postural control and gross motor function in three young children with cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) levels IV or V. Method: Children (N = 3) between the ages of 2–3 years who were diagnosed with CP classified as GMFCS levels IV and V participated in BWSTT three times per week. The Segmental Assessment of Trunk Control (SATCo) and the gross motor function measure (GMFM-66) were assessed before and after the 6-week intervention. Results: Final testing revealed that all participants improved on the SATCo and GMFM. Conclusion: BWSTT is a viable intervention that may improve trunk control and gross motor outcomes in young children with severe CP. Further research is needed to explore the impact of BWSTT for young children classified as GMFCS levels IV and V. [ABSTRACT FROM AUTHOR]

Introduction: Recently published studies show remarkable improvements in functional mobility after treadmill training with HAL® in patients with spinal cord injuries. The aim of this study was to evaluate the impact of HAL®-assisted treadmill training on quality of life. Patient/Method: A case series of six patients participating in a single-centre prospective, interventional pilot study, who were suffering neurologic motor deficits. The quality of life was assessed using the EQ-5D questionnaire and mobility was assessed using the PROMIS v1.2 Physical Function – Mobility Score before treadmill training, at 12-weeks, and at 6-months. Results: Five out of six patients showed improvement in the PROMIS v1.2 Physical Function – Mobility score. Four patients did not show changes in the EQ-5D at 6 months follow-up, relative to baseline. The EQ-5D score of one patient worsened while improved in another patient at 6 months follow-up compared to the baseline. Conclusion: Our study details the first experience in a larger series regarding the effects of HAL®-assisted treadmill training on quality of life. Whereas five out of six patients showed improvements in mobility scores, only one patient showed improvement of life quality at 6 months follow-up. Life quality is influenced by a multitude of factors and lager randomized trials are needed to assess the effect of HAL®-assisted training on quality of life. Treadmill training with HAL is safe and feasible for patients with neurologic disorders Treadmill training with HAL improved the functional mobility Improvements in the quality of life were unverifiable [ABSTRACT FROM AUTHOR]

Purpose: Discuss the effectiveness of locomotor training (LT) in children following spinal cord injury (SCI). This intervention was assessed following an exhaustive search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement as a guideline. Method: Six databases were searched including PubMed, PEDro, CINAHL, Cochrane, PsycINFO, and Web of Knowledge in January 2016 and November 2016, without date restrictions. Inclusion criteria were: studies in English and peer-reviewed and journal articles with a primary intervention of LT in children following SCI. Results: Twelve articles, reporting eleven studies, were included. A systematic review assessing locomotor training in children with SCI published in April 2016 was also included. Participants were ages 15 months to 18 years old. Forms of LT included body-weight supported treadmill or over ground training, functional electrical stimulation, robotics, and virtual reality. Protocols differed in set-up and delivery mode, with improvements seen in ambulation for all 41 participants following LT. Conclusion: Children might benefit from LT to develop or restore ambulation following SCI. Age, completeness, and level of injury remain the most important prognostic factors to consider with this intervention. Additional benefits include improved bowel/ bladder management and control, bone density, cardiovascular endurance, and overall quality of life. Looking beyond the effects LT has just on ambulation is crucial because it can offer benefits to all children sustaining a SCI, even if restoration or development of walking is not the primary goal. Further rigorous research is required to determine the overall effectiveness of LT. [ABSTRACT FROM AUTHOR]

Patients who have undergone unicompartmental knee arthroplasty (UKA) have been reported to exhibit altered gait 19-25 months post-surgery. The most common gait impairment in this population is inadequate knee flexion and a corresponding decrease in the knee extensor moment during loading response (i.e., quadriceps avoidance). The purpose of this case series was to determine whether incorporation of antigravity treadmill training into a standard physical therapy program can eliminate quadriceps avoidance gait during the early rehabilitation phase following UKA. Four females who underwent UKA were recruited for this study. Participants completed antigravity treadmill training three times per week for 12 weeks in addition to their standard physical therapy program. Instrumented gait analysis was performed at baseline (pre-intervention), week 6 (mid-intervention), and week 12 (post-intervention). We found that peak knee flexion and the peak knee extensor moment during the weight acceptance phase of gait increased to normal values following the 12-week intervention period (14.1 ± 6.5° to 20.6 ± 1.5° and 0.4 ± 0.3 to 0.7 ± 0.2 Nm/kg respectively). The findings of this case series suggest that a standard physical therapy program that incorporates early gait training using an antigravity treadmill may be beneficial in eliminating "quadriceps avoidance" during the early rehabilitation phase following UKA. [ABSTRACT FROM AUTHOR]

Background: Gait impairment is common in stroke survivors. Recovery of walking ability is one of the most pressing objectives in stroke rehabilitation. Objectives: Of this report are to briefly review recent progress in gait training after stroke including the use of partial body weight-supported treadmill training (PBWSTT) and robot-assisted step training (RAST), and propose a minimal assistance strategy that may overcome some of limitations of current RAST. Methods: The literature review emphasizes a dilemma that recent randomized clinical trials did not support the use of RAST. The unsatisfactory results of current RAST clinical trials may be partially due to a lack of careful analysis of movement deficiencies and their relevance to gait training task specificity after stroke. Normal movement pattern is implied to be part of task specificity in the current RAST. Limitations of such task specificity are analyzed. Results: Based on the review, we redefine an alternative set of gait training task specificity that represents a minimal assistance strategy in terms of assisted body movements and amount of assistance. Specifically, assistances are applied only to hip flexion and ankle dorsiflexion of the affected lower limb during swing phase. Furthermore, we propose a conceptual design of a novel device that may overcome limitations of current RAST in gait training after stroke. The novel device uses a pulling cable, either manually operated by a therapist or automated by a servomotor, to provide assistive forces to help hip flexion and ankle dorsiflexion of the affected lower limb during gait training. Conclusion: The proposed minimal assistance strategy may help to design better devices for gait or other motor training. [ABSTRACT FROM AUTHOR]

Background: Physical activity and exercise interventions are useful in facilitating the functional recovery of those with chronic stroke and, routinely, are gait-specific. While treadmill training has proven useful in gait performance recovery post-stroke, its efficacy on balance dysfunction has not been  systematically reviewed. Objectives:The purpose of this systematic review was to determine the effect of treadmill training (TT) interventions on balance dysfunction in individuals with chronic stroke. Methods:A systematic literature search of PubMed, EMBASE, and CINAHL was performed. Eligible randomized controlled trials were published between 2007 and 2016. Selected trials investigated TT interventions in persons with chronic stroke and implemented at least one objective balance measure. Methodological quality was assessed using PEDro criteria. Results:Eight studies met eligibility criteria and were included in the qualitative analysis. Studies differed in TT implementation and use of adjunctive treatments; however, all trials demonstrated improvements in balance measures that were as effective, if not more so, than conventional physical therapy treatments, including targeted balance training. Conclusions:This review recognized moderate evidence in favor of TT interventions in balance and stroke rehabilitation programs. With TT,intensitymay be a more critical factor thanspecificityand may offer additional carryover to recovery parameters of postural control and balance, beyond gait performance. It is recommended that clinicians utilizing TT incorporate objective measures of balance to assess the potential for skill transference and improvements in balance. Higher quality studies and additional research are needed to denote critical parameters by which improvements in balance may be optimized. [ABSTRACT FROM PUBLISHER]

Objective: To determine whether goal-directed group circuit progressive resistance exercise training (GT) can improve motor function in adolescents with cerebral palsy (CP) and to compare outcomes with a treadmill training (TT) intervention. Methods: In a multi-centered matched pairs study, 95 adolescents with spastic CP (GMFCS II-III) were allocated to GT or TT interventions for 30 bi-weekly one hour training. Outcome measures of GMFM-66, GMFM-D%, GMFM-E%, TUG, 10 meter walk test (10 MWT), and 6 minute walk test (6 MWT) were made at baseline (T1), after interventions (T2) and 6 months post training (T3). Results: Both training programs induced significant improvement in all outcome measures (T2–T1) that were mostly retained at T3. At the end of the intervention, the GT group showed an advantage in all measured changes compared to the TT group and in percentage changes. Differences were significant (p < 0.02) for GMFM-66, GMFM-D%, GMFM-E% and TUG. The advantage trend for the GT group was less apparent at follow up (T3–T1). Conclusion: Both programs were effective in improving motor function in adolescents with cerebral palsy. The GT program had generally greater benefits based on the functional measures. [ABSTRACT FROM AUTHOR]

Background and Purpose: Contemporary approaches to the treatment of cerebral palsy (CP) advocate a task-specific approach that emphasizes repetition and practice of specific tasks. Recent studies suggest that body-weight-supported treadmill training (BWSTT) programs may be beneficial in clinical settings. The purposes of this case series were to explore the outcomes and feasibility of a home-based BWSTT program for three children with CP. Case Description: Three children with CP at Gross Motor Function Classification System (GMFCS) Levels III or IV participated in this case series. Examination included the Functional Assessment Questionnaire (FAQ), the 10-meter walk test, the Gross Motor Function Measure (GMFM-66), and the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT). A harness system was used to conduct the BWSTT program over an 8–12 week period. Outcomes: All of the families reported enjoying the BWSTT program and found the harness easy to use. Participant 2 increased from a 2 to a 4 on the FAQ, while Participant 3 increased from a 6 to a 7. Discussion: Two of the participants demonstrated post-intervention improvements in functional mobility. In addition to mobility outcomes, future research should explore the potential health benefits of a home-based BWSTT program. [ABSTRACT FROM AUTHOR]

Background and Objectives: While body weight support (BWS) intonation is vital during conventional gait training of neurologically challenged subjects, it is important to evaluate its effect during robot assisted gait training. In the present research we have studied the effect of BWS intonation on muscle activities during robotic gait training using dynamic simulations. Methods: Two dimensional (2-D) musculoskeletal model of human gait was developed conjointly with another 2-D model of a robotic orthosis capable of actuating hip, knee and ankle joints simultaneously. The musculoskeletal model consists of eight major muscle groups namely; soleus (SOL), gastrocnemius (GAS), tibialis anterior (TA), hamstrings (HAM), vasti (VAS), gluteus maximus (GLU), uniarticular hip flexors (iliopsoas, IP), and Rectus Femoris (RF). BWS was provided at levels of 0, 20, 40 and 60% during the simulations. In order to obtain a feasible set of muscle activities during subsequent gait cycles, an inverse dynamics algorithm along with a quadratic minimization algorithm was implemented. Results: The dynamic parameters of the robot assisted human gait such as joint angle trajectories, ground contact force (GCF), human limb joint torques and robot induced torques at different levels of BWS were derived. The patterns of muscle activities at variable BWS were derived and analysed. For most part of the gait cycle (GC) the muscle activation patterns are quite similar for all levels of BWS as is apparent from the mean of muscle activities for the complete GC. Conclusions: Effect of BWS variation during robot assisted gait on muscle activities was studied by developing dynamic simulation. It is expected that the proposed dynamic simulation approach will provide important inferences and information about the muscle function variations consequent upon a change in BWS during robot assisted gait. This information shall be quite important while investigating the influence of BWS intonation on neuromuscular parameters of interest during robotic gait training. [ABSTRACT FROM AUTHOR]

Background/Purpose: Individuals with incomplete spinal cord injuries (ISCIs) commonly face persistent gait impairments. Backward walking training may be a useful rehabilitation approach, providing novel gait and balance challenges. However, little is known about the effects of this approach for individuals with ISCIs. The purpose of this case report was to describe the effects of backward walking training on strength, balance, and upright mobility in an individual with chronic ISCI. Methods: A 28-year-old female, 11-years post ISCI (C4, AIS D) completed 18-sessions of backward walking training on a treadmill with partial body-weight support and overground. Training emphasized stepping practice, speed, and kinematics. Outcome measures included: Lower Extremity Motor Score, Berg Balance Scale (BBS), Sensory Organization Test (SOT), 10-Meter Walk Test (10MWT), 3-meter backward walking test, Timed Up and Go (TUG), and Activities-Specific Balance Confidence (ABC) Scale. Results: Strength did not change. Improved balance was evident based on BBS (20 to 37/56) and SOT scores (27 to 40/100). Upright mobility improved based on TUG times (57 to 32.7 s), increased 10MWT speed (0.23 to 0.31 m/s), and backward gait speed (0.07 to 0.12 m/s). Additionally, self-reported balance confidence (ABC Scale) increased from 36.9% to 49.6%. Conclusions: The results suggest that backward walking may be a beneficial rehabilitation approach; examination of the clinical efficacy is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the combined effect of robotic-aided gait training (RAGT) and physical therapy (PT) on functional abilities and gait pattern in children and adolescents exiting acquired brain injury (ABI), through functional clinical scales and 3D-Gait Analysis (GA). Methods: A group of 23 patients with ABI underwent 20 sessions of RAGT in addition to traditional manual PT. All the patients were evaluated before and after the training by using the Gross Motor Function Measures (GMFM) and the Functional Assessment Questionnaire. Ambulant children were also evaluated through the 6 Minutes Walk Test (6MinWT) and GA. Finally, results were compared with those obtained from a control group of ABI children who underwent PT only. Results: After the training, the GMFM showed significant improvement in both dimensions 'D' (standing) and 'E' (walking). In ambulant patients the 6MinWT showed significant improvement after training and GA highlighted a significant increase in cadence, velocity and stride length. Moreover, hip kinematics on the sagittal plane revealed a statistically significant increase in range of motion (ROM) during the whole gait cycle, increased hip extension during terminal stance and increased ROM during the swing phase. Conclusions: The data suggest that the combined programme RAGT + PT induces improvements in functional activities and gait pattern in children and adolescents with ABI and demonstrated it to be an elective tool for the maintenance of the patients' full compliance throughout the rehabilitative programme. [ABSTRACT FROM AUTHOR]