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Background: The core stability program is commonly utilized as an intervention method to improve postural control. This study aimed to evaluate the effect of core stability exercises on upper limb reaching in children with hemiparetic cerebral palsy (CP). For this purpose, 30 hemiparetic CP children of both sexes were recruited for the study. The children were between the ages of 4 and 6. According to the modified Ashworth scale (MAS), the degree of spasticity varied from 1 to 1 + , and for children who were selected, the average Trunk Control Measurement Scale (TCMS) ranged from 25 to 42. Children were assigned into two groups at random (study group and control group). The pediatric reach test (PRT) was used to assess each child both before and after two consecutive months of therapy. The children in both groups received the same program of selected physical therapy exercises, but the children in the study group also performed the selected physical therapy program in addition to the core stability exercises. Results: By comparing the mean values of all assessed variables before and after therapy, both groups improved significantly (p = 0.0001). When comparing post-treatment outcomes, there were significant differences between the control and study groups in all assessed variables (p = 0.0001) in favor of the study group. Conclusion: Core stability exercises may be used to improve reaching in children with hemiparetic cerebral palsy. Trial registration: This study was authorized by the Faculty of Physical Therapy's ethics committee under the number "REC/012/003125" and registered in ClinicalTrial.gov with the number "NCT05316090" on 9 April 2022 retrospectively. [ABSTRACT FROM AUTHOR]

Abstract Background The core stability program is commonly utilized as an intervention method to improve postural control. This study aimed to evaluate the effect of core stability exercises on upper limb reaching in children with hemiparetic cerebral palsy (CP). For this purpose, 30 hemiparetic CP children of both sexes were recruited for the study. The children were between the ages of 4 and 6. According to the modified Ashworth scale (MAS), the degree of spasticity varied from 1 to 1 + , and for children who were selected, the average Trunk Control Measurement Scale (TCMS) ranged from 25 to 42. Children were assigned into two groups at random (study group and control group). The pediatric reach test (PRT) was used to assess each child both before and after two consecutive months of therapy. The children in both groups received the same program of selected physical therapy exercises, but the children in the study group also performed the selected physical therapy program in addition to the core stability exercises. Results By comparing the mean values of all assessed variables before and after therapy, both groups improved significantly (p = 0.0001). When comparing post-treatment outcomes, there were significant differences between the control and study groups in all assessed variables (p = 0.0001) in favor of the study group. Conclusion Core stability exercises may be used to improve reaching in children with hemiparetic cerebral palsy. Trial registration This study was authorized by the Faculty of Physical Therapy’s ethics committee under the number “REC/012/003125” and registered in ClinicalTrial.gov with the number “NCT05316090” on 9 April 2022 retrospectively.

Stiff knee gait (SKG) occurrence after a stroke is associated with various abnormal muscle activities; however, the interactions among these muscles are unclear. This study aimed to elucidate the muscle synergy characteristics during walking in patients with SKG after a stroke. This cross-sectional study included 20 patients with poststroke SKG (SKG group), 16 patients without poststroke SKG (non-SKG group), and 15 healthy adults (control group). Participants walked a 10-m distance at a comfortable speed, and electromyographic data were recorded from six lower-limb muscles. Non-negative matrix factorization was employed to derive time-varying activity (C), muscle weights (W), and the percentage of total variance accounted for (tVAF) for muscle synergies. The SKG group showed a higher tVAF than the control group. The initial stance module (including knee extensors) showed increased activity during the swing phase. The initial swing module (including hip flexors and ankle dorsiflexors) exhibited a higher activity during the single-support phase but a lower activity during the swing phase. The synergy structure in patients with SKG after stroke was simplified, with specific abnormalities in synergy activities. SKG may arise from several synergy alterations involving multiple muscles, indicating that approaches focused on controlling individual muscle activities are unsuitable. [ABSTRACT FROM AUTHOR]

Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other. Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation. The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001). The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population. The stepwatch activity monitor worn on the hemiparetic limb provided the best accuracy and excellent reliability for step counts in this population of subacute stroke. For percent standing time all devices overestimated with poor reliability. For percent other time, the AP had the best accuracy and good reliability on the non-hemiparetic limb. The use of multiple devices may be warranted to capture a more accurate understanding of activity level in this population of individuals with sub-acute stroke. Clinicians and researchers need to be aware of the biases of these devices in this population. [ABSTRACT FROM AUTHOR]

Hemiparetic gait disorders are common in stroke survivors. A circumductory gait is often considered the typical hemiparetic gait. In clinical practice, a wide spectrum of abnormal gait patterns is observed, depending on the severity of weakness and spasticity, and the anatomical distribution of spasticity. Muscle strength is the key determinant of gait disorders in hemiparetic stroke survivors. Spasticity and its associated involuntary activation of synergistic spastic muscles often alter posture of involved joint(s) and subsequently the alignment of hip, knee, and ankle joints, resulting in abnormal gait patterns. Due to combinations of various levels of muscle weakness and spasticity and their interactions with ground reaction force, presentations of gait disorders are variable. From a neuromechanical perspective, a stepwise visual gait analysis approach is proposed to identify primary underlying causes. In this approach, the pelvic and hip joint movement is examined first. The pelvic girdle constitutes three kinematic determinants. Its abnormality determines the body vector and compensatory kinetic chain reactions in the knee and ankle joints. The second step is to assess the ankle and foot complex abnormality. The last step is to examine abnormality of the knee joint. Assessment of muscle strength and spasticity of hip, knee, and ankle/foot joints needs to be performed before these steps. Lidocaine nerve blocks can be a useful diagnostic tool. Recognizing different patterns and identifying the primary causes are critical to developing clinical interventions to improve gait functions. [ABSTRACT FROM AUTHOR]

Background and Purpose: Cerebral palsy is a non-progressive brain lesion, which causes severe hand impairment in children with hemiparetic cerebral palsy as well. In this study, we aimed to compare the effect of Reciprocal Electrical Stimulation (RES) versus Kinesio Taping (KT) on fine motor skills in children with hemiparetic cerebral palsy. Materials and Methods: Sixty children of either sex aged 4-5 years having hand spasticity were selected for inclusion based on a modified Ashworth scale grade between 1 to 1+. They were randomly assigned into two equivalent groups (Groups I and II). In group I, RES targeting wrist flexors and extensors was used with an individualized physical therapy program while in group II KT was applied at the wrist flexors and extensors plus the same physical treatment as in group I had. Before evaluating the Peabody Developmental Motor Scale-2 (PDMS-2), grasping and visual motor integration subtests were measured at baseline and after 12 weeks of intervention. Results: There were no significant differences between the two groups before treatment regarding mean values of all parameters (p > 0.05). Nonetheless, it was statistically significant that Group I attained higher results than Group II after the intervention period (p < 0.05). Conclusion: both Reciprocal Electrical Stimulation (RES) and Kinesio Taping (KT) were effective in improving fine motor skills among children with hemiparetic cerebral palsy although RES was much more effective. [ABSTRACT FROM AUTHOR]

Stretching is a widely used method for managing spasticity. It involves elongating muscles and soft tissues to improve flexibility and range of motion. We aimed to evaluate the effectiveness and usability of static stretching utilizing a Hand-Wrist Stretching Device (HWSD) that we developed for managing spasticity and improving the motor function in individuals with chronic post-stroke hemiparesis. A repeated experiment was conducted to assess the effectiveness and usability of the HWSD. The HWSD includes a forearm holder, a frame, a finger holder, adjustable hinges, straps, and thumb stretchers. The Modified Ashworth Scale (MAS), the Box and Block Test (BBT), and a subjective usability questionnaire were used for evaluation. The results of applying the MAS revealed a significant difference with time and stretching angle for the elbow (p < 0.05). Both the elbow and wrist showed a significant decrease in MAS scores, and the BBT results demonstrated a significant improvement after stretching (p < 0.05). The subjective perception ratings consistently remained above 4.0. The HWSD effectively relieves hand spasticity and improves hand mobility in chronic stroke patients. Subjective perception ratings were positive. In future studies, the application of HWSD to patients with various forms of spasticity can be explored and its long-term effects investigated. [ABSTRACT FROM AUTHOR]

Auditory feedback has earlier been explored as a tool to enhance patient awareness of gait kinematics during rehabilitation. In this study, we devised and tested a novel set of concurrent feedback paradigms on swing phase kinematics in hemiparetic gait training. We adopted a user-centered design approach, where kinematic data recorded from 15 hemiparetic patients was used to design three feedback algorithms (wading sounds, abstract, musical) based on filtered gyroscopic data from four inexpensive wireless inertial units. The algorithms were tested (hands-on) by a focus group of five physiotherapists. They recommended that the abstract and musical algorithms be discarded due to sound quality and informational ambiguity. After modifying the wading algorithm (as per their feedback), we conducted a feasibility test involving nine hemiparetic patients and seven physiotherapists, where variants of the algorithm were applied to a conventional overground training session. Most patients found the feedback meaningful, enjoyable to use, natural-sounding, and tolerable for the typical training duration. Three patients exhibited immediate improvements in gait quality when the feedback was applied. However, minor gait asymmetries were found to be difficult to perceive in the feedback, and there was variability in receptiveness and motor change among the patients. We believe that our findings can advance current research in inertial sensor-based auditory feedback for motor learning enhancement during neurorehabilitation. [ABSTRACT FROM AUTHOR]

Nowadays, a classification system for unilateral stiff-knee gait (SKG) kinematic severity in hemiparetic adult patients after stroke does not exist. However, such classification would be useful to the clinicians. We proposed the use of the k-means method in order to define unilateral SKG severity clusters in hemiparetic adults after stroke. A retrospective k-means cluster analysis was applied to five selected knee kinematic parameters collected during gait in 96 hemiparetic adults and 19 healthy adults from our clinical gait analysis database. A total of five discrete knee kinematic clusters were determined. Three clusters of SKG were identified, based on which a three-level severity classification was defined: unbend-knee gait, braked-knee gait, and frozen-limb gait. Preliminary construct validity of the classification was obtained. All selected knee kinematic parameters defining the five clusters and the majority of usual kinematic parameters of the lower limbs showed statistically significant differences between the different clusters. We recommend diagnosing SKG for values strictly below 40° of knee flexion during the swing phase. Clinicians and researchers are now able to specify the level of kinematic severity of SKG in order to optimize treatment choices and future clinical trial eligibility criteria. [ABSTRACT FROM AUTHOR]

The purpose of this study was to clarify whether the novel lateral transfer assist robot facilitates easier transfers compared with a wheelchair in post-stroke hemiparesis patients. This cross-sectional study enrolled 20 post-stroke hemiparesis patients, and the task difficulty of transfers was compared between a wheelchair and lateral transfer assist robot. All participants were asked to transfer from either wheelchair or lateral transfer assist robot to a platform table and back. The primary outcome was the transfer score of the Functional Independence Measure. The secondary outcome was the time required for transfer. The transfer score of the Functional Independence Measure was significantly higher with lateral transfer assist robot than with wheelchair (p <.001). The transfer times from these devices to a platform table and back showed no significant differences (to device from platform table: 7.8 s, lateral transfer assist robot vs 7.6 s, wheelchair, p >.05: device to platform table: 7.1 s, lateral transfer assist robot vs 8.0 s, wheelchair, p >.05). Transfer with a lateral transfer assist robot is easier than with wheelchair and facilitates independence in post-stroke hemiparesis patients. Transfer skill influences the functional independence and quality of life of a wheelchair user A novel structural mobility device—the lateral transfer assist robot (LTAR)—can facilitate transfers The LTAR could improve the degree of independence for transfers than the wheelchair, without any time loss, in post-stroke hemiparesis patients The LTAR could potentially reduce the risk for falls in various medical and care facilities [ABSTRACT FROM AUTHOR]

Brain asymmetry is connected with motor performance, suggesting that hemiparetic patients have different gait patterns depending on the side of the lesion. This retrospective cohort study aims to further investigate the difference between right and left hemiplegia in order to assess whether the injured side can influence the patient's clinical characteristics concerning gait, thus providing insights for new personalized rehabilitation strategies. The data from 33 stroke patients (17 with left and 16 with right hemiplegia) were retrospectively compared with each other and with a control group composed of 20 unaffected age-matched individuals. The 3D gait analysis was used to assess kinematic data and spatio-temporal parameters. Compared to left hemiplegic patients, right hemiplegic patients showed worse spatio-temporal parameters (p < 0.05) and better kinematic parameters (p < 0.05). Both pathological groups were characterized by abnormal gait parameters in comparison with the control group (p < 0.05). These findings show an association between the side of the lesion—right or left—and the different stroke patients' gait patterns: left hemiplegic patients show better spatio-temporal parameters, whereas right hemiplegic patients show better segmentary motor performances. Therefore, further studies may develop and assess new personalized rehabilitation strategies considering the injured hemisphere and brain asymmetry. [ABSTRACT FROM AUTHOR]

Objectives: The ability to transfer between surfaces is essential for wheelchair users’ independence. We hypothesized that transfer of hemiparetic stroke patients would be improved by using surfaces at the same height with no gap or obstacle between them. Methods: A cross-sectional study was conducted to compare the difficulty of two transfer methods as a pilot study. Thirteen hemiparetic stroke patients were transferred from a platform table to a chair (wheelchair or flat chair) and from the chair to the table using the regular and lateral transfer methods. Functional Independence Measure (FIM) transfer score in both transfer methods and Stroke Impairment Assessment Set (SIAS) score were measured. Results: The FIM transfer score significantly increased in the lateral transfer condition compared with the regular transfer condition, indicating that the former method reduced the transfer difficulty, regardless of the SIAS scores. Conclusions: The transfer difficulty of patients with hemiparetic stroke decreases when using the lateral transfer method. The lateral transfer method is easy, potentially helping prevent care-related injuries among caregivers.

Abstract Background The anterior-posterior ground reaction force (AP-GRF) and propulsion and braking point metrics derived from the AP-GRF time series are indicators of locomotor function across healthy and neurological diagnostic groups. In this paper, we describe the use of a minimal set of wearable inertial measurement units (IMUs) to indirectly measure the AP-GRFs generated during healthy and hemiparetic walking. Methods Ten healthy individuals and five individuals with chronic post-stroke hemiparesis completed a 6-minute walk test over a walking track instrumented with six forceplates while wearing three IMUs securely attached to the pelvis, thigh, and shank. Subject-specific models driven by IMU-measured thigh and shank angles and an estimate of body acceleration provided by the pelvis IMU were used to generate indirect estimates of the AP-GRF time series. Propulsion and braking point metrics (i.e., peaks, peak timings, and impulses) were extracted from the IMU-generated time series. Peaks and impulses were expressed as % bodyweight (%bw) and peak timing was expressed as % stance phase (%sp). A 75%-25% split of 6-minute walk test data was used to train and validate the models. Indirect estimates of the AP-GRF time series and point metrics were compared to direct measurements made by the forceplates. Results Indirect measurements of the AP-GRF time series approximated the direct measurements made by forceplates, with low error and high consistency in both the healthy (R M S E= 4.5%bw; R 2= 0.93) and post-stroke (R M S E= 2.64%bw; R 2= 0.90) cohorts. In the healthy cohort, the average errors between indirect and direct measurements of the peak propulsion magnitude, peak propulsion timing, and propulsion impulse point estimates were 2.37%bw, 0.67%sp, and 0.43%bw. In the post-stroke cohort, the average errors for these point estimates were 1.07%bw, 1.27%sp, and 0.31%bw. Average errors for the braking estimates were higher, but comparable. Conclusions Accurate estimates of AP-GRF metrics can be generated using three strategically mounted IMUs and subject-specific calibrations. This study advances the development of point-of-care diagnostic systems that can catalyze the routine assessment and management of propulsion and braking locomotor deficits during rehabilitation.

Background: The anterior-posterior ground reaction force (AP-GRF) and propulsion and braking point metrics derived from the AP-GRF time series are indicators of locomotor function across healthy and neurological diagnostic groups. In this paper, we describe the use of a minimal set of wearable inertial measurement units (IMUs) to indirectly measure the AP-GRFs generated during healthy and hemiparetic walking.Methods: Ten healthy individuals and five individuals with chronic post-stroke hemiparesis completed a 6-minute walk test over a walking track instrumented with six forceplates while wearing three IMUs securely attached to the pelvis, thigh, and shank. Subject-specific models driven by IMU-measured thigh and shank angles and an estimate of body acceleration provided by the pelvis IMU were used to generate indirect estimates of the AP-GRF time series. Propulsion and braking point metrics (i.e., peaks, peak timings, and impulses) were extracted from the IMU-generated time series. Peaks and impulses were expressed as % bodyweight (%bw) and peak timing was expressed as % stance phase (%sp). A 75%-25% split of 6-minute walk test data was used to train and validate the models. Indirect estimates of the AP-GRF time series and point metrics were compared to direct measurements made by the forceplates.Results: Indirect measurements of the AP-GRF time series approximated the direct measurements made by forceplates, with low error and high consistency in both the healthy (RMSE= 4.5%bw; R2= 0.93) and post-stroke (RMSE= 2.64%bw; R2= 0.90) cohorts. In the healthy cohort, the average errors between indirect and direct measurements of the peak propulsion magnitude, peak propulsion timing, and propulsion impulse point estimates were 2.37%bw, 0.67%sp, and 0.43%bw. In the post-stroke cohort, the average errors for these point estimates were 1.07%bw, 1.27%sp, and 0.31%bw. Average errors for the braking estimates were higher, but comparable.Conclusions: Accurate estimates of AP-GRF metrics can be generated using three strategically mounted IMUs and subject-specific calibrations. This study advances the development of point-of-care diagnostic systems that can catalyze the routine assessment and management of propulsion and braking locomotor deficits during rehabilitation. [ABSTRACT FROM AUTHOR]

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

Study aim: To determine whether a physiotherapy protocol improves the electromyographic activation (EA) during the hemiparetic gait in patients with delayed access to rehabilitation.

This study analyzes the immediate effects of wearing a Therasuit on sagittal plane lower limb angular displacements during gait in children with unilateral spastic cerebral palsy (US-CP). Seven participants (median age = 7.00 years; ranging from 5.83 to 9.00 years) with US-CP, levels I and II of the Gross Motor Function Classification System, were assessed with kinematic gait analysis in three different conditions: (A) Baseline; (B) Therasuit without elastics and (C) Therasuit with elastics. Significant improvements were observed at the hip joint of both lower limbs during most of the gait cycle in participants wearing a Therasuit, including a decrease in the flexion pattern at the initial contact and swing phase in both lower limbs, and an increase in the extension pattern in the paretic lower limb during the stance phase. At the knee joint in the paretic lower limb, significant differences were found between the baseline and Therasuit with elastics conditions on the knee angle at initial contact, and between baseline and both Therasuit conditions on the flexion angle at swing phase. However, the inter-individual variability in kinematic patterns at the knee joint was high. At the ankle joint, decreased plantar flexion at initial contact and increased dorsiflexion during stance and swing phases were observed at the Therasuit with elastics condition, helping to correct the equinus-foot in the paretic lower limb during the whole gait cycle. The Z-values showed large effect sizes particularly for most of the angular hip variables in both lower limbs and for the angular ankle variables in the paretic lower limb. The Therasuit seems to have some positive immediate effects on gait kinematics in children with spastic unilateral cerebral palsy by providing a more functional and safer gait pattern. Future investigations with larger samples are recommended to further support these findings.

Restoring mobility and rehabilitation of gait are high priorities for post-stroke rehabilitation. Cueing using metronomic rhythmic sensory stimulation has been shown to improve gait, but most versions of this approach have used auditory and visual cues. In contrast, we developed a prototype wearable system for rhythmic cueing based on haptics, which was shown to be highly effective in an early pilot study. In this paper we describe a follow-up study with four stroke survivors to inform design, and to identify issues and requirements for such devices to be used in home-based or out-door settings. To this end, we present a blended user-centred design study of a wearable haptic gait rehabilitation system. This study draws on the combined views of physiotherapists, nurses, interaction designers and stroke survivors. Many of the findings were unanticipated, identifying issues outside the scope of initial designs, with important implications for future design and appropriate use.

Post-stroke gait dysfunction occurs at a very high prevalence. A practical method to quantitatively analyze the characteristics of hemiparetic gait is needed in both clinical and community settings. This study developed a 10-channeled textile capacitive pressure sensing insole (TCPSI) with a real-time monitoring system and tested its performance through hemiparetic gait pattern analysis. Thirty-five subjects (18 hemiparetic, 17 healthy) walked down a 40-m long corridor at a comfortable speed while wearing TCPSI inside the shoe. For gait analysis, the percentage of the plantar pressure difference (PPD), the step count, the stride time, the coefficient of variation, and the phase coordination index (PCI) were used. The results of the stroke patients showed a threefold higher PPD, a higher step count (41.61 ± 10.7), a longer average stride time on the affected side, a lower mean plantar pressure on the affected side, higher plantar pressure in the toe area and the lateral side of the foot, and a threefold higher PCI (hemi: 19.50 ± 13.86%, healthy: 5.62 ± 5.05%) compared to healthy subjects. This study confirmed that TCPSI is a promising tool for distinguishing hemiparetic gait patterns and thus may be used as a wearable gait function evaluation tool, the external feedback gait training device, and a simple gait pattern analyzer for both hemiparetic patients and healthy individuals.

Aims:The majority of people develop hemiparetic shoulder inferior subluxation following stroke, but the timing of onset is unknown. This study aimed to assess changes in glenohumeral joint centre of rotation (GHJC) during the first six weeks following stroke. Methods:Thirty patients with confirmed diagnosis of stroke (age 65 ± 19 years, 60% female, 40% right side affected) were assessed within 14 days of admission and at six weeks along with matched controls. Bilateral GHJC was determined using a three-dimensional electromagnetic tracking device (ETD). Results:At baseline, GHJC in the stroke group was positioned posteriorly on the hemiparetic side compared to the non-hemiparetic side (mean difference −4.0, 95% confidence interval (CI) − 7.7 to −3.0 mm). In matched controls, GHJC was positioned anterior to the acromion with no significant difference between limbs. At six weeks, the only significant difference occurred for the stroke group; non-hemiparetic GHJC was positioned 12.3 mm (95% CI 2.5–22.1) closer to the acromion compared with control group. Conclusion:Minimal changes in glenohumeral joint positioning occurs early post-stroke. Clinicians should consider changes in glenohumeral joint position for both non- and hemiparetic sides during the early rehabilitation phase following stroke.Implications for rehabilitationChanges occur in glenohumeral joint centre of rotation (GHJC) position between hemiparetic and non-hemiparetic sides early in people with mild stroke.Clinicians need to be aware of early GHJC positional changes.Early GHJC positional changes may contribute to the development of hemiparetic shoulder pain (HSP), anterior humeral subluxation and glenohumeral joint impingement.Clinicians should employ current best practice guidelines which promote safe positioning and handling of the upper limb to minimise subluxation forces and potential trauma to the passive restraints of the shoulder in the acute phase following stroke, to reduce the possibility of glenohumeral subluxation in the short term. [ABSTRACT FROM PUBLISHER]

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

Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. Methods: For this feasibility study a small sample size of 14 participants (3 – 60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n=7) or wait list control (n=7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes.

Machine learning methods have been widely used for gait assessment through the estimation of spatio-temporal parameters. As a further step, the objective of this work is to propose and validate a general probabilistic modeling approach for the classification of different pathological gaits. Specifically, the presented methodology was tested on gait data recorded on two pathological populations (Huntington's disease and post-stroke subjects) and healthy elderly controls using data from inertial measurement units placed at shank and waist. By extracting features from group-specific Hidden Markov Models (HMMs) and signal information in time and frequency domain, a Support Vector Machines classifier (SVM) was designed and validated. The 90.5% of subjects was assigned to the right group after leave-one-subject-out cross validation and majority voting. The long-term goal we point to is the gait assessment in everyday life to early detect gait alterations. [ABSTRACT FROM AUTHOR]

The aim of rehabilitation after stroke is to improve the functional performance of hemiparetics. The Group of Physiotherapy in the form of Circuit Training (GPCT) uses specific functional exercises focusing on repetition and continuous progression of exercises in a number of workstations arranged in a circuit format, to improve functional capacity. The objective this study was to evaluate the gait performance in chronic hemiparetics undergo six months of treatment in GPCT. The hemiparetics were evaluated with the 10-meter walking test and Time up and go test (TUG). The results showed see that the therapeutic use has not been able to significantly change motor performance, however it can be inferred that patients had the opportunity to benefit from exercise and increase their participation in society improving psychosocial aspects. [ABSTRACT FROM AUTHOR]

Background: Impairment of upper limb function following stroke is more common than lower limb impairment and is also more resistant to treatment. Several lab-based studies with stroke patients have produced statistically significant gains in upper limb function when using musical instrument playing and techniques where rhythm acts as an external time-keeper for the priming and timing of upper limb movements. Methods: For this feasibility study a small sample size of 14 participants (3-60 months post stroke) has been determined through clinical discussion between the researcher and study host in order to test for management, feasibility and effects, before planning a larger trial determined through power analysis. A cross-over design with five repeated measures will be used, whereby participants will be randomized into either a treatment (n = 7) or wait list control (n = 7) group. Intervention will take place twice weekly over 6 weeks. The ARAT and 9HPT will be used to measure for quantitative gains in arm function and finger dexterity, pre/post treatment interviews will serve to investigate treatment compliance and tolerance. A lab based EEG case comparison study will be undertaken to explore audio-motor coupling, brain connectivity and neural reorganization with this intervention, as evidenced in similar studies. Discussion: Before evaluating the effectiveness of a home-based intervention in a larger scale study, it is important to assess whether implementation of the trial methodology is feasible. This study investigates the feasibility, efficacy and patient experience of a music therapy treatment protocol comprising a chart of 12 different instrumental exercises and variations, which aims at promoting measurable changes in upper limb function in hemiparetic stroke patients. The study proposes to examine several new aspects including home-based treatment and dosage, and will provide data on recruitment, adherence and variability of outcomes. [ABSTRACT FROM AUTHOR]

Background The aim of the present study is to demonstrate, through tests with healthy volunteers, the feasibility of potentially assisting individuals with neurological disorders via a portable assistive technology for the upper extremities (UE). For this purpose the task of independently drinking a glass of water was selected, as it is one of the most basic and vital activities of the daily living that is unfortunately not achievable by individuals severely affected by stroke. Methods To accomplish the aim of this study we introduce a wearable and portable system consisting of a novel lightweight Robotic Arm Orthosis (RAO), a Functional Electrical Stimulation (FES) system, and a simple wireless Brain-Computer Interface (BCI). This system is able to process electroencephalographic (EEG) signals and translate them into motions of the impaired arm. Five healthy volunteers participated in this study and were asked to simulate stroke patient symptoms with no voluntary control of their hand and arm. The setup was designed such as the volitional movements of the healthy volunteers' UE did not interfere with the evaluation of the proposed assistive system. The drinking task was split into eleven phases of which seven were executed by detecting EEG-based signals through the BCI. The user was asked to imagine UE motion related to the specific phase of the task to be assisted. Once detected by the BCI the phase was initiated. Each phase was then terminated when the BCI detected the volunteers clenching their teeth. Results The drinking task was completed by all five participants with an average time of 127 seconds with a standard deviation of 23 seconds. The incremental motions of elbow extension and elbow flexion were the primary limiting factors for completing this task faster. The BCI control along with the volitional motions also depended upon the users pace, hence the noticeable deviation from the average time. Conclusion Through tests conducted with healthy volunteers, this study showed that our proposed system has the potential for successfully assisting individuals with neurological disorders and hemiparetic stroke to independently drink from a glass. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a systematic literature review focusing on the use of virtual reality (VR) for the improvement of gait in post-stroke patients. Methods: We performed a search of Randomized-controlled trials published from 1966 to 2011 in the databases: Medline, Lilacs, CINAHL, Cochrane and SciELO. Keywords used in the selection were: Virtual reality in combination with (AND) 'Nervous System Diseases', (OR) 'Motor Skill Disorders' (OR) 'neurologic impairments' (OR) 'motor function' (OR) function* (OR) locomotion (OR) ambulation (OR) gait (OR) 'motor activity' (OR) Stroke. Selected articles were evaluated using the individual's components of methodological quality assessment and analysis of outcomes of each study was based on the domains of the International Classification of Functioning, Disability and Health (ICF). Results: A total of 6520 references were found, however, based on the inclusion and exclusion criteria only four studies were considered and analyzed. These articles demonstrated that the use of VR promotes changes in gait parameters, despite the diversity of protocols, participants' characteristics, as well as the number of participants included in each study. Conclusions: The research studies analyses suggest that VR is a promising method to improve the gait of patients with stroke. Nevertheless, some questions still need to be answered. Some aspects should be investigated to confirm the true benefits and application of VR in this population. [ABSTRACT FROM AUTHOR]

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

The brain’s response to somatosensory stimuli is essential to experience-driven learning in children. It was hypothesized that advances in event-related potential technology could quantify the response to touch in somatosensory cortices and characterize the responses of hemiparetic children. In this prospective study of 8 children (5-8 years old) with hemiparetic cerebral palsy, both event-related potential responses to sham or air puff trials and standard functional assessments were used. Event-related potential technology consistently measured signals reflecting activity in the primary and secondary somatosensory cortices as well as complex cognitive processing of touch. Participants showed typical early responses but less efficient perceptual processes. Significant differences between affected and unaffected extremities correlated with sensorimotor testing, stereognosis, and 2-point discrimination (r > 0.800 and P = .001 for all). For the first time, a novel event-related potential paradigm shows that hemiparetic children have slower and less efficient tactile cortical perception in their affected extremities. [ABSTRACT FROM PUBLISHER]

Following stroke, control of both the contralesional (paretic) and ipsilesional (less affected) arms is altered. The purpose of this study was to analyse the consequences of stroke on joint rotations of both shoulder girdles, that is, glenohumeral (GH) and scapula motion. Because of hemispheric specialization, we hypothesized that changes would relate to the side of hemisphere damage. Nine stroke patients with left, and 9 with right hemisphere damage (LHD and RHD) and 9 healthy subjects were included. Reaching movements to targets positioned close, far and high in three directions were recorded using an electromagnetic system. Initial and final postures of the scapula, GH and elbow joint were evaluated. Inter-joint rotations throughout the movements were analysed using principal component analysis (PCA). The main finding was that initial and final postures of the contralesional and ipsilesional shoulders differed depending on the side of brain lesion. On the contralesional side, there was less scapula protraction and GH lateral rotation for both groups. Scapula tilt was less anterior in LHD patients, and GH elevation was greater in RHD patients. On the ipsilesional side, GH lateral rotation was reduced in both groups, and scapula protraction was reduced only for LHD patients. PCA confirmed that postures of both shoulders of the LHD group were substantially different to the healthy subjects, while only the contralesional arm of the RHD subjects differed. These results add to existing knowledge of hemispheric specialization, suggesting that the left hemisphere plays a greater role in bilateral joint postures than the right hemisphere. [ABSTRACT FROM AUTHOR]

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Aim: To examine the influence of combining restraint therapy with bimanual intensive therapy on the unimanual and bimanual function among children with hemiparetic cerebral palsy (CP). Included were nine children (ages 6-9 yr), with Manual Ability Classification System scores of 2-3, Gross Motor Functional Classification System 1-2; Intervention: 10 days, six hours per day including one hour of restraint followed by five hours of bimanual activities. Evaluations: One month and immediately prior to the intervention (as the control period), immediately, two months and six months post-intervention. The Assisting Hand Assessment was the primary outcome measure, along with the Jebsen-Taylor Test of Hand Function, the Jamar pinch gauge for grip and pinch, and the Pediatric Evaluation of Disability Inventory (PEDI). Results: No significant change was observed during the pre-intervention control period in any of the outcome measures; a significant improvement in all outcome parameters was noted after the intervention as compared to the control period. These achievements were still significantly higher than baseline values at six months post-intervention. Conclusion: Children with hemiparetic CP at this level of impairment might benefit from a short daily intervention program of combining restraint with bimanual training in order to improve unimanual and bimanual function. [ABSTRACT FROM AUTHOR]

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

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

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

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

Objectives: To test the hypothesis that quantitative measures of cardiovascular fitness and ambulatory function differ in Black and White hemiparetic stroke survivors. Design: Cross-sectional analysis. Setting: Outpatient academic medical center. Participants: Total of 118 hemiparetic stroke survivors. Main Outcome Measures: Cardiovascular fitness was measured as VO2 peak and ambulatory function using the six-minute walk distance and 30-foot walking velocity in medically screened, community-dwelling stroke survivors. Results: In 118 subjects (56% Black and 44% White), no differences were seen in 1) VO2 peak between Black or White men (15.0+/-4.3 vs. 15.1+/-3.9 mL/kg/minute) or women (11.5+/-2.7 vs. 12.3+/-3.7 mL/kg/minute); 2) six-minute walk distance between Black or White men (223+/-112 m vs 226+/-132 m) or women (198+/-100 vs 157+/-93 m); or 3) 30-foot walking velocity between Black or White men (0.60+/-0.27 m/second vs 0.61+/-0.31 m/ second) or women (0.50+/-0.21 m/second vs 0.41+/-0.23 m/second). Conclusion: No racial differences were seen in the degree of physical deconditioning in a selected population of community dwelling hemiparetic stroke survivors. [ABSTRACT FROM AUTHOR]

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

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