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Traxler K, Baum E, Klotz E, Reindl M, Schinabeck F, Seebacher B. Combining specific task-oriented training with manual therapy to improve balance and mobility in patients after stroke: a mixed methods pilot randomised controlled trial. Disabil Rehabil 2024; 46:1318-1329. [PMID: 37051907 DOI: 10.1080/09638288.2023.2193432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/16/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE In absence of existing studies, to describe changes in balance and mobility, following specific task-oriented training (TOT), its combination with talocrural manual therapy (MT-TOT) or no intervention, in chronic stroke patients. To explore the feasibility of a full-scale randomised controlled trial (RCT) based on criteria of recruitment, retention and adherence rates, adverse events, falls and acceptability of the intervention. MATERIALS AND METHODS Using an assessor-blinded pilot RCT, 36 stroke patients were allocated to either MT-TOT, TOT, or controls. Supervised interventions were performed 45 min, 2×/weekly, for 4 weeks, and home-based practice 20 min, 4x/weekly for 4 weeks. Qualitative interviews evaluated intervention acceptability. Outcomes of balance, mobility, ankle dorsiflexion range of motion (ROM), falls and health-related quality of life (HRQoL) were assessed at baseline, post-intervention and 4-week follow-up. RESULTS Preliminary efficacy of MT-TOT and TOT was shown in improving balance (effect size 0.714), walking speed (0.683), mobility (0.265), dual-tasking mobility (0.595), falls (0.037), active and passive talocrural ROM (0.603; 0.751) and activities and social participation related HRQoL domains (0.332-0.784) in stroke patients. The feasibility of a larger RCT was confirmed. CONCLUSIONS Specific MT-TOT and TOT appeared effective and are feasible in stroke patients. A larger RCT is needed to validate the results.Trial Registration: German Clinical Trials Register, DRKS00023068. Registered on 21.09.2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023068.
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Affiliation(s)
- Kristina Traxler
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
- Department for Health Sciences, Medicine and Research, Danube University Krems, Austria
| | - Eva Baum
- Therapiezentrum Kinema, Neukirchen b. hl. Blut, Germany
| | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - Franz Schinabeck
- Überörtliche Gemeinschaftspraxis Hohenwarth/Lam, Hohenwarth, Germany
| | - Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
- VASCage, Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria
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Rodriguez Hernandez KE, De Groot JH, Baas F, Stijntjes M, Grootendorst-Heemskerk ERM, Schiemanck SK, van der Helm FCT, van der Kooij H, Mugge W. Ankle-Foot-Orthosis "Hermes" Compensates Pathological Ankle Stiffness of Chronic Stroke-A Proof of Concept. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3535-3544. [PMID: 37647177 DOI: 10.1109/tnsre.2023.3310337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Individuals with an upper motor neuron syndrome, e.g., stroke survivors, may have a pathological increase of passive ankle stiffness due to spasticity, that impairs ankle function and activities such as walking. To improve mobility, walking aids such as ankle-foot orthoses and orthopaedic shoes are prescribed. However, these walking aids generally limit the range of motion (ROM) of the foot and may therewith negatively influence activities that require a larger ROM. Here we present a new ankle-foot orthosis "Hermes", and its first experimental results from four hemiparetic chronic stroke patients. Hermes was designed to facilitate active ankle dorsiflexion by mechanically compensating the passive ankle stiffness using a negative-stiffness mechanism. Four levels of the Hermes' stiffness compensation (0%, 35%, 70% and 100%) were applied to evaluate active ROM in a robotic ankle manipulator and to test walking feasibility on an instrumented treadmill, in a single session. The robotic tests showed that Hermes successfully compensated the ankle joint stiffness in all four patients and improved the active dorsiflexion ROM in three patients. Three patients were able to walk with Hermes at one or more Hermes' stiffness compensation levels and without reducing their preferred walking speeds compared to those with their own walking aids. Despite a small sample size, the results show that Hermes holds great promise to support voluntary ankle function and to benefit walking and daily activities.
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Tesfazgi S, Sangouard R, Endo S, Hirche S. Uncertainty-aware automated assessment of the arm impedance with upper-limb exoskeletons. Front Neurorobot 2023; 17:1167604. [PMID: 37692885 PMCID: PMC10490610 DOI: 10.3389/fnbot.2023.1167604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Providing high degree of personalization to a specific need of each patient is invaluable to improve the utility of robot-driven neurorehabilitation. For the desired customization of treatment strategies, precise and reliable estimation of the patient's state becomes important, as it can be used to continuously monitor the patient during training and to document the rehabilitation progress. Wearable robotics have emerged as a valuable tool for this quantitative assessment as the actuation and sensing are performed on the joint level. However, upper-limb exoskeletons introduce various sources of uncertainty, which primarily result from the complex interaction dynamics at the physical interface between the patient and the robotic device. These sources of uncertainty must be considered to ensure the correctness of estimation results when performing the clinical assessment of the patient state. In this work, we analyze these sources of uncertainty and quantify their influence on the estimation of the human arm impedance. We argue that this mitigates the risk of relying on overconfident estimates and promotes more precise computational approaches in robot-based neurorehabilitation.
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Affiliation(s)
- Samuel Tesfazgi
- Chair of Information-oriented Control (ITR), TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
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Quantitative measurement of resistance force and subsequent attenuation during passive isokinetic extension of the wrist in patients with mild to moderate spasticity after stroke. J Neuroeng Rehabil 2022; 19:110. [PMID: 36224659 PMCID: PMC9559851 DOI: 10.1186/s12984-022-01087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Spasticity is evaluated by measuring the increased resistance to passive movement, primarily by manual methods. Few options are available to measure spasticity in the wrist more objectively. Furthermore, no studies have investigated the force attenuation following increased resistance. The aim of this study was to conduct a safe quantitative evaluation of wrist passive extension stiffness in stroke survivors with mild to moderate spastic paresis using a custom motor-controlled device. Furthermore, we wanted to clarify whether the changes in the measured values could quantitatively reflect the spastic state of the flexor muscles involved in the wrist stiffness of the patients. Materials and methods Resistance forces were measured in 17 patients during repetitive passive extension of the wrist at velocities of 30, 60, and 90 deg/s. The Modified Ashworth Scale (MAS) in the wrist and finger flexors was also assessed by two skilled therapists and their scores were averaged (i.e., average MAS) for analysis. Of the fluctuation of resistance, we focused on the damping just after the peak forces and used these for our analysis. A repeated measures analysis of variance was conducted to assess velocity-dependence. Correlations between MAS and damping parameters were analyzed using Spearman’s rank correlation. Results The damping force and normalized value calculated from damping part showed significant velocity-dependent increases. There were significant correlations (ρ = 0.53–0.56) between average MAS for wrist and the normalized value of the damping part at 90 deg/s. The correlations became stronger at 60 deg/s and 90 deg/s when the MAS for finger flexors was added to that for wrist flexors (ρ = 0.65–0.68). Conclusions This custom-made isokinetic device could quantitatively evaluate spastic changes in the wrist and finger flexors simultaneously by focusing on the damping part, which may reflect the decrease in resistance we perceive when manually assessing wrist spasticity using MAS. Trial registration UMIN Clinical Trial Registry, as UMIN000030672, on July 4, 2018
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Nojiri E, Wada Y, Mochizuki M, Sugiyama M, Kawate N. Immediate effect of different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle on walking ability in individuals with chronic stroke: a randomized crossover trial. J Phys Ther Sci 2022; 34:485-491. [PMID: 35784608 PMCID: PMC9246403 DOI: 10.1589/jpts.34.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate how different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle affect the walking ability in individuals with chronic stroke. [Participants and Methods] In this randomized crossover study, participants underwent a 10-m walking test and walked on a WalkWay MW-1000 three times under these conditions: (1) without ankle-foot orthosis; (2) with ankle-foot orthosis with an adjustable posterior strut at 5° of fixed dorsiflexion; and (3) with ankle-foot orthosis with an adjustable posterior strut at 5-20° of restricted dorsiflexion. The primary outcome was walking speed on the 10-m walking test. The secondary outcomes were walking speed and spatiotemporal factors measured by the WalkWay MW-1000. [Results] Fifteen individuals (mean [standard deviation] age, 60.9 [8.6] years; male, 12) were enrolled. Walking speeds of the ankle-foot orthosis with fixed and restricted dorsiflexion groups were significantly higher than those without the orthosis; however, no outcomes differed significantly between ankle-foot orthosis with fixed versus restricted dorsiflexion groups. [Conclusion] In individuals with chronic stroke, ankle-foot orthosis function may be less important than the dorsiflexed setting of initial ankle joint angle in the ankle-foot orthosis.
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Affiliation(s)
- Eri Nojiri
- Department of Rehabilitation Medicine, Graduate School of Medicine, Showa University, Japan.,Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
| | - Yoshitaka Wada
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University: 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - Midori Mochizuki
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
| | - Mizuki Sugiyama
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Graduate School of Medicine, Showa University, Japan.,Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
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Cao J, Xiao Y, Qiu W, Zhang Y, Dou Z, Ren J, Zheng R, Zheng H, Chen Z. Reliability and diagnostic accuracy of corrected slack angle derived from 2D-SWE in quantitating muscle spasticity of stroke patients. J Neuroeng Rehabil 2022; 19:15. [PMID: 35120556 PMCID: PMC8817514 DOI: 10.1186/s12984-022-00995-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/25/2022] [Indexed: 12/21/2022] Open
Abstract
Background To explore the feasibility of corrected slack angle acquired from two-dimensional shear wave elastography (2D-SWE) for quantitating the spasticity of medial gastrocnemius (MG) in stroke patients. Methods Consecutive stroke patients with spastic MG and matched healthy controls were recruited. Intra- and interobserver reliability of 2D-SWE measurement were evaluated, and the correlation between corrected slack angle and modified Ashworth scale (MAS) score was examined. The corrected slack angle before and after botulinum toxin A (BoNT-A) injection was compared and its diagnostic performance in classifying the severity of spasticity were assessed with receiver operating characteristic (ROC) curve analysis. Results The intra- (0.791 95% CI 0.432–0.932) and interobserver (0.751 95% CI 0.382–0.916) reliability of slack angle acquired with 2D-SWE were good. Significant correlation was found between corrected slack angle and MAS score (R = − 0.849, p < 0.001). The corrected slack angle increased after BoNT-A injection. The cutoff value of MAS ≥ 3 had the highest sensitivity (100%) and specificity (93.33%). The positive predictive value (PPV) for classification of MAS ≥ 1+ and the negative predictive value (NPV) for classification of MAS ≥ 3 were greater than 90%. Conclusion 2D-SWE was a reliable method to quantitate the post-stroke spasticity. The corrected slack angle had advantage in classifying the severity of spasticity, especially in early identification of mild spasticity and confirmation of severe spasticity. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00995-8.
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Affiliation(s)
- Junyan Cao
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yang Xiao
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, 518055, China
| | - Weihong Qiu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Yanling Zhang
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jie Ren
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen, 518055, China
| | - Zhaocong Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, China.
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Zhai X, Wu Q, Li X, Xu Q, Zhang Y, Fan S, Zhang LQ, Pan Y. Effects of Robot-Aided Rehabilitation on the Ankle Joint Properties and Balance Function in Stroke Survivors: A Randomized Controlled Trial. Front Neurol 2021; 12:719305. [PMID: 34721259 PMCID: PMC8549728 DOI: 10.3389/fneur.2021.719305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Stroke survivors with impaired control of the ankle due to stiff plantarflexors often experience abnormal posture control, which affects balance and locomotion. Forceful stretching may decrease ankle stiffness and improve balance. Recently, a robot-aided stretching device was developed to decrease ankle stiffness of patient post-stroke, however, their benefits compared to manual stretching exercises have not been done in a randomized controlled trial, and the correlations between the ankle joint biomechanical properties and balance are unclear. Objective: To compare the effects of robot-aided to manual ankle stretching training in stroke survivors with the spastic ankle on the ankle joint properties and balance function post-stroke, and further explore the correlations between the ankle stiffness and balance. Methods: Twenty inpatients post-stroke with ankle spasticity received 20 minutes of stretching training daily over two weeks. The experimental group used a robot-aided stretching device, and the control group received manual stretching. Outcome measures were evaluated before and after training. The primary outcome measure was ankle stiffness. The secondary outcome measures were passive dorsiflexion ranges of motion, dorsiflexor muscle strength, Modified Ashworth Scale (MAS), Fugl-Meyer Motor Assessment of Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and the Pro-Kin balance test. Results: After training, two groups showed significantly within-group improvements in dorsiflexor muscle strength, FMA-LE, BBS, MBI (P < 0.05). The between-group comparison showed no significant differences in all outcome measures (P > 0.0025). The experimental group significantly improved in the stiffness and passive range of motion of dorsiflexion, MAS. In the Pro-Kin test, the experimental group improved significantly with eyes closed and open (P < 0.05), but significant improvements were found in the control group only with eyes open (P < 0.05). Dorsiflexion stiffness was positively correlated with the Pro-Kin test results with eyes open and the MAS (P < 0.05). Conclusions: The robot-aided and manual ankle stretching training provided similar significant improvements in the ankle properties and balance post-stroke. However, only the robot-aided stretching training improved spasticity and stiffness of dorsiflexion significantly. Ankle dorsiflexion stiffness was correlated with balance function. Clinical Trial Registration:www.chictr.org.cn ChiCTR2000030108.
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Affiliation(s)
- Xiaoxue Zhai
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qiong Wu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Xin Li
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Quan Xu
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yanlin Zhang
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Senchao Fan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States.,Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
| | - Yu Pan
- Department of Rehabilitation, Beijing Tsinghua Changgung Hospital, Beijing, China.,School of Clinical Medicine, Tsinghua University, Beijing, China
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Zunko H, Vauhnik R. Reliability of the weight-bearing ankle dorsiflexion range of motion measurement using a smartphone goniometer application. PeerJ 2021; 9:e11977. [PMID: 34616594 PMCID: PMC8464192 DOI: 10.7717/peerj.11977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background Weight-bearing ankle dorsiflexion range of motion measurement (weight-bearing lunge test) is gaining in popularity because it mimics lower extremity function in daily physical activities. The purpose of the study is to assess the intra-rater and the inter-rater reliability of the weight-bearing ankle dorsiflexion range of motion measurement with a flexed knee using a smartphone application Spirit Level Plus installed on an Android smartphone. Methods Thirty-two young, healthy subjects participated in the study and were measured in four sessions by two examiners. One measurement was taken on each ankle in every session. Eight measurements were taken from each participant. A total of 256 were taken from all the participants. The measurements for the individual subject were repeated no sooner than 24 hours after the first session. In order to assess the reliability, intraclass correlation coefficients (ICC), standard error measurements (SEM) and minimal detectable change (MDC) at the 95% confidence interval were calculated. Results Statistical data analysis revealed moderate intra-rater reliability for the right ankle (ICC = 0.72, 95% CI [0.49–0.85]) and good intra-rater reliability for the left ankle (ICC = 0.82, 95% CI [0.66–0.91]). Inter-rater reliability is moderate for the right (ICC = 0.73, 95% CI [0.52–0.86]) and the left ankle (ICC = 0.65, 95% CI [0.39–0.81]). Conclusion The observed method is moderately reliable and appropriate when the main objective is to assess ankle dorsiflexion mobility in weight-bearing when weight-bearing is not contraindicated. The concurrent validity of the Spirit Level Plus application is excellent.
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Affiliation(s)
- Helena Zunko
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia
| | - Renata Vauhnik
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia.,Arthron, Institute for Joints and Sport Injuries, Slovenia, Ljubljana, Slovenia
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9
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Alamer A, Melese H, Getie K, Deme S, Tsega M, Ayhualem S, Birhanie G, Abich Y, Yitayeh Gelaw A. Effect of Ankle Joint Mobilization with Movement on Range of Motion, Balance and Gait Function in Chronic Stroke Survivors: Systematic Review of Randomized Controlled Trials. Degener Neurol Neuromuscul Dis 2021; 11:51-60. [PMID: 34512072 PMCID: PMC8420562 DOI: 10.2147/dnnd.s317865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Ankle joint mobilization with movement has been speculated to be an important intervention for enhancing range of motion, balance, and gait functions in chronic stroke survivors. Nonetheless, there is a scarcity of recent conclusive evidence that evaluates its efficacy in chronic stroke patients. The purpose of this review was to synthesize existing evidence on the efficacy of mobilization with movement therapy on range of motion, balance, and gait performance in subjects after stroke. Methods A comprehensive systematic search of literature was performed using the following databases: PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of included trials. The primary outcome measures of this review were dorsiflexion range of motion (DF-ROM), and Berg balance scale (BBS). This review was reported in accordance with PRISMA statement guidelines. Due to variations in relevant trials, meta-analysis was not carried out. Results and Conclusions Seven randomized controlled trials with a total of 224 subjects were analyzed. Evidence of overall quality was graded from moderate to high. This review found that mobilization with movement therapy could be an alternative rehabilitative intervention for subjects with chronic stroke to increase range of motion, balance, and gait ability. However, the evidence remains preliminary due to the small number of participants. Large-scale RCTs in the future are warranted to investigate the efficacy of mobilization with movement in subgroups of chronic stroke subjects.
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Affiliation(s)
- Abayneh Alamer
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Haimanot Melese
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Kefale Getie
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Sisay Deme
- Department of Physiotherapy, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Molla Tsega
- Department of Internal Medicine, School of Medicine, College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Sileshi Ayhualem
- Department of Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremeskel Birhanie
- Department of Physiotherapy, School of Medicine, College of Health Sciences, TibebeGhion Comprehensive Specialized Hospital, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yohannes Abich
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmare Yitayeh Gelaw
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hodge JO, Brandmeir CL, Brandmeir NJ. Neuromodulation Therapies for Spasticity Control: Now and Beyond. Neurol India 2021; 68:S241-S248. [PMID: 33318358 DOI: 10.4103/0028-3886.302464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Spasticity is a major cause of disability following upper motor neuron (UMN) injury. The diagnosis and treatment of spasticity has been a focus of clinicians and researchers alike. In recent years, there have been significant advances both in strategies for spasticity assessment and in the development of novel treatments. Currently, several well-established spasticity management techniques fall into the major categories of physiotherapy, pharmacotherapy, and surgical management. The majority of recent developments in all of these broad categories have focused more on methods of neuromodulation instead of simple symptomatic treatment, attempting to address the underlying cause of spasticity more directly. The following narrative review briefly discusses the causes and clinical assessment of spasticity and also details the wide variety of current and developing treatment approaches for this often-debilitating condition.
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Affiliation(s)
- Johnie O Hodge
- Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WV, United States
| | - Cheryl L Brandmeir
- Department of Human Performance, West Virginia University, Morgantown, WV, United States
| | - Nicholas J Brandmeir
- Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WV, United States
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11
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Ha SY, Han JH, Ko YJ, Sung YH. Ankle exercise with functional electrical stimulation affects spasticity and balance in stroke patients. J Exerc Rehabil 2020; 16:496-502. [PMID: 33457385 PMCID: PMC7788250 DOI: 10.12965/jer.2040780.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/22/2020] [Indexed: 11/22/2022] Open
Abstract
Stroke patients have limited motor function due to ankle spasticity, and various interventions are applied to solve this problem. The purpose of this study was to investigate the effects of functional electrical stimulation (FES) with ankle exercise on spinal cord motor neuron excitability and balance in stroke patients. Twenty-five stroke patients were divided into the three groups. For the intervention, the control group applied general physiotherapy, the experimental group I applied a sham FES with ankle exercise, and the experimental group II applied a FES with ankle exercise. All groups applied the intervention for 30 min per session, 5 times a week, for a total of 8 weeks. The functional reaching test (FRT), Timed Up and Go test was used to measure balance ability, and H-reflex was used to measure spinal motor neuron excitability. All tests were measured before and after the intervention. In the ankle exercise with FES group, spinal motor neuron excitability significantly decreased (P<0.05), and FRT was significantly increased (P<0.05). Therefore, FES with ankle exercise for stroke patients could be suggested as an effective intervention for improving motor function.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon, Korea
| | - Jun-Ho Han
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon, Korea
| | - Young Jun Ko
- Major in Sport Service Practice, College of Welfare Covergence, Kangnam University, Yongin, Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon, Korea.,Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon, Korea
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12
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Tsai LC, Wu YN, Liu SQ, Zhang LQ. Changes in Muscle Stress and Sarcomere Adaptation in Mice Following Ischemic Stroke. Front Physiol 2020; 11:581846. [PMID: 33408638 PMCID: PMC7781356 DOI: 10.3389/fphys.2020.581846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
While abnormal muscle tone has been observed in people with stroke, how these changes in muscle tension affect sarcomere morphology remains unclear. The purpose of this study was to examine time-course changes in passive muscle fiber tension and sarcomeric adaptation to these changes post-ischemic stroke in a mouse model by using a novel in-vivo force microscope. Twenty-one mice were evenly divided into three groups based on the time point of testing: 3 days (D3), 10 days (D10), and 20 days (D20) following right middle cerebral artery ligation. At each testing time, the muscle length, width, and estimated volume of the isolated soleus muscle were recorded, subsequently followed by in-vivo muscle tension and sarcomere length measurement. The mass of the soleus muscle was measured at the end of testing to calculate muscle density. Two-way ANOVA with repeated measures was used to examine the differences in each of the dependent variable among the three time-point groups and between the two legs. The passive muscle stress of the impaired limbs in the D3 group (27.65 ± 8.37 kPa) was significantly lower than the less involved limbs (42.03 ± 18.61 kPa; p = 0.05) and the impaired limbs of the D10 (48.92 ± 14.73; p = 0.03) and D20 (53.28 ± 20.54 kPa; p = 0.01) groups. The soleus muscle density of the impaired limbs in the D3 group (0.69 ± 0.12 g/cm3) was significantly lower than the less involved limbs (0.80 ± 0.09 g/cm3; p = 0.04) and the impaired limbs of the D10 (0.87 ± 0.12 g/cm3; p = 0.02) and D20 (1.00 ± 0.14 g/cm3; p < 0.01) groups. The D3 group had a shorter sarcomere length (2.55 ± 0.26 μm) than the D10 (2.83 ± 0.20 μm; p = 0.03) and D20 group (2.81 ± 0.15 μm; p = 0.04). These results suggest that, while ischemic stroke may cause considerable changes in muscle tension and stress, sarcomere additions under increased mechanical loadings may be absent or disrupted post-stroke, which may contribute to muscle spasticity and/or joint contracture commonly observed in patients following stroke.
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Affiliation(s)
- Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, GA, United States
| | - Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Shu Q. Liu
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
- Department of Orthopaedics, University of Maryland, Baltimore, MD, United States
- Department of Bioengineering, University of Maryland, College Park, MD, United States
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Park D, Cynn HS. Effects of Walking With Talus-Stabilizing Taping on Passive Range of Motion, Timed Up and Go, Temporal Parameters of Gait, and Fall Risk in Individuals With Chronic Stroke: A Cross-sectional Study. J Manipulative Physiol Ther 2020; 44:49-55. [PMID: 33248745 DOI: 10.1016/j.jmpt.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effects of walking with talus-stabilizing taping on ankle dorsiflexion passive range of motion, the timed up-and-go test, temporal parameters of gait, and fall risk in individuals with chronic stroke. METHODS In this cross-sectional design study, 20 participants with chronic stroke (9 female, 11 male), aged 60.5 ± 8.1 years, were included. Three conditions were evaluated: barefoot, immediately after applying talus-stabilizing taping, and after 5 minutes of walking with talus-stabilizing taping. One-way repeated-measures analysis of variance was used to determine the differences in ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk across the 3 conditions. RESULTS Ankle dorsiflexion passive range of motion, walking speed, and single-limb support phase were significantly improved after 5 minutes of walking with talus-stabilizing taping compared to those in the barefoot and immediately-after-taping conditions. The timed up-and-go test, double-limb support phase, and fall-risk results significantly decreased more after 5 minutes of walking with talus-stabilizing taping compared to barefoot and immediately after taping. CONCLUSION After the application of talus-stabilizing taping, ankle dorsiflexion passive range of motion, timed up-and-go test results, temporal parameters of gait, and fall risk were reduced in individuals with chronic stroke.
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Affiliation(s)
- Donghwan Park
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea
| | - Heon-Seock Cynn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of Korea.
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Lee DH, Chang WN, Jeon HJ. Comparison of ground reaction force during gait between the nonparetic side in hemiparetic patients and the dominant side in healthy subjects. J Exerc Rehabil 2020; 16:344-350. [PMID: 32913839 PMCID: PMC7463072 DOI: 10.12965/jer.2040488.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/16/2020] [Indexed: 12/05/2022] Open
Abstract
Considering the occurrence of gait impairment following stroke, walk-ing recovery is an important goal of rehabilitation. Ground reaction force (GRF) is used for gait assessment of rehabilitation progress during exercise in stroke patients. The aim of this study was to compare the GRF during gait of the nonparetic side in hemiparetic patients and the dominant side in healthy subjects. Twenty hemiparetic patients and 20 healthy subjects were enrolled in the study. Force plate was used to evaluate GRF during gait. Additionally, with the patients and subjects in supine position, we measured their range of motion (ROM) in ankle dor-siflexion using a digital goniometer. The force values of stance phase on the nonparetic side of hemiparetic patients were significantly less than on the dominant side of healthy subjects (P<0.05). The impulse values of stance phase on the paretic side and the nonparetic side of hemiparetic patients were significantly greater than on the dominant side of healthy subjects (P<0.05). The ankle ROM result was signifi-cantly correlated with the GRF values (P<0.05). It is important to assess and understand the nonparetic side as well as paretic side. These re-sults suggest that the analysis of GRF for exercise rehabilitation will be a valuable clinical evaluation in hemiparetic patients after a stroke.
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Affiliation(s)
- Dae-Hee Lee
- Department of Physical Therapy, U1 University, Yeongdong, Korea
| | - Woo-Nam Chang
- Department of Physical Therapy, Yongin University, Yongin, Korea
| | - Hye-Joo Jeon
- Department of Physical Therapy, U1 University, Yeongdong, Korea
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Cha Y, Arami A. Quantitative Modeling of Spasticity for Clinical Assessment, Treatment and Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5046. [PMID: 32899490 PMCID: PMC7571189 DOI: 10.3390/s20185046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/23/2022]
Abstract
Spasticity, a common symptom in patients with upper motor neuron lesions, reduces the ability of a person to freely move their limbs by generating unwanted reflexes. Spasticity can interfere with rehabilitation programs and cause pain, muscle atrophy and musculoskeletal deformities. Despite its prevalence, it is not commonly understood. Widely used clinical scores are neither accurate nor reliable for spasticity assessment and follow up of treatments. Advancement of wearable sensors, signal processing and robotic platforms have enabled new developments and modeling approaches to better quantify spasticity. In this paper, we review quantitative modeling techniques that have been used for evaluating spasticity. These models generate objective measures to assess spasticity and use different approaches, such as purely mechanical modeling, musculoskeletal and neurological modeling, and threshold control-based modeling. We compare their advantages and limitations and discuss the recommendations for future studies. Finally, we discuss the focus on treatment and rehabilitation and the need for further investigation in those directions.
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Affiliation(s)
- Yesung Cha
- Neuromechanics and Assistive Robotics Laboratory, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada;
| | - Arash Arami
- Neuromechanics and Assistive Robotics Laboratory, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada;
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON M5G 2A2, Canada
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Huang HY, Farkhatdinov I, Arami A, Bouri M, Burdet E. Cable-Driven Robotic Interface for Lower Limb Neuromechanics Identification. IEEE Trans Biomed Eng 2020; 68:461-469. [PMID: 32746036 DOI: 10.1109/tbme.2020.3004491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper presents a versatile cable-driven robotic interface to investigate the single-joint joint neuromechanics of the hip, knee and ankle in the sagittal plane. This endpoint-based interface offers highly dynamic interaction and accurate position control (as is typically required for neuromechanics identification), and provides measurements of position, interaction force and electromyography (EMG) of leg muscles. It can be used with the subject upright, corresponding to a natural posture during walking or standing, and does not impose kinematic constraints on a joint, in contrast to existing interfaces. Mechanical evaluations demonstrated that the interface yields a rigidity above 500 N/m with low viscosity. Tests with a rigid dummy leg and linear springs show that it can identify the mechanical impedance of a limb accurately. A smooth perturbation is developed and tested with a human subject, which can be used to estimate the hip neuromechanics.
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Park SJ, Kim TH, Oh S. Immediate Effects of Tibialis Anterior and Calf Muscle Taping on Center of Pressure Excursion in Chronic Stroke Patients: A Cross-Over Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114109. [PMID: 32526916 PMCID: PMC7312188 DOI: 10.3390/ijerph17114109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/16/2022]
Abstract
Stroke patients often have muscles spasticity, difficulty with posture control, and tend to fall. This study investigated the use of kinesiology tape for patients with spasticity of ankle muscles after stroke. This study had a randomized, repeated measures design, and evaluated the immediate effect of kinesiology tape on the center of pressure (COP) excursion when applied to the calf and tibialis anterior muscles in stroke survivors. We determined that the taping attachment direction affects the COP movement. Twenty subjects were randomly assigned to the tibialis anterior taping condition, calf taping condition, or nontaping condition. Condition excursion was assessed. The measured variables included the paretic side area, nonparetic side area, forward area, and backward area of COP. All evaluations were conducted immediately after taping. COP excursion for chronic stroke survivors improved after tibialis anterior and calf taping (p < 0.05). Calf taping conditions increased significantly in the forward area (p < 0.05), and tibialis anterior taping conditions increased significantly in the backward area (p < 0.05). Kinesiology tape immediately increased the forward and backward COP excursion for patients with stroke.
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Affiliation(s)
- Shin Jun Park
- Department of Physical Therapy, Gangdong University, 278, Daehak-gil, Gamgok-myeon, Eumseong-gun, Chungcheongbuk-do 27600, Korea;
| | - Tae-Hyun Kim
- NEULBOM Hospital 17, Poeun-daero 59 beon-gil, Suji-gu, Yongin-si, Gyeonggi-do 16864, Korea;
| | - Seunghue Oh
- Department of Physical Therapy, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 330-714, Korea
- Correspondence: ; Tel.: +82-41-550-6103; Fax: 82-41-559-7934
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Immediate Effects of Ankle-Foot Orthosis Using Wire on Static Balance of Patients with Stroke with Foot Drop: A Cross-Over Study. Healthcare (Basel) 2020; 8:healthcare8020116. [PMID: 32354201 PMCID: PMC7349351 DOI: 10.3390/healthcare8020116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to investigate the immediate static balance effects of bare foot, UD-Flex ankle–foot orthosis (AFO), and AFO using wire (AOW) of patients with stroke with foot drop. Seventeen patients with stroke with foot drop (8 men and 9 women) were randomized to three conditions (bare foot, UD-Flex AFO, or AOW made with a flexible material). Static balance was assessed using the Zebris (Zebris GmbH, Isny, Germany) and BioRescue (RM Ingenierie, Rodez, France) pressure platform by a single examiner, who did not design the AOW. The order of testing with the equipment was random. The center of pressure path length (mm) measured using Zebris showed significant differences among the three conditions (bare foot, 484.47 ± 208.42; UD-Flex AFO, 414.59 ± 144.43; AOW, 318.29 ± 157.60) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but was significantly different from the AOW condition (p < 0.05). The surface area ellipse (mm2) measured using BioRescue showed significant differences among the three conditions (bare foot, 241.35 ± 153.76; UD-Flex AFO, 277.41 ± 381.83; AOW, 68.06 ± 48.98) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but the AOW condition was significantly different from the bare-foot (p < 0.05) and from the UD-Flex AFO conditions (p < 0.05). We suggest using the AOW made of flexible materials and wire instead of the UD-Flex AFO to improve immediate static balance of patients with stroke with foot drop after stroke. Further studies on the effects of dynamic balance and gait are required.
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Chardon MK, Suresh NL, Dhaher YY, Rymer WZ. In-Vivo Study of Passive Musculotendon Mechanics in Chronic Hemispheric Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1022-1031. [PMID: 32149642 DOI: 10.1109/tnsre.2020.2972206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We characterized the passive mechanical properties of the affected and contralateral musculotendon units in 9 chronic stroke survivors as well as in 6 neurologically-intact controls. Using a position-controlled motor, we precisely indented the distal tendon of the biceps brachii to a 20 mm depth from skin, recording both its sagittal motion using ultrasound movies and the compression force at the tip of the indenter. Length changes of 8 equally-spaced features along the aponeurosis axis were quantified using a pixel-tracking protocol. We report that, on the aggregate and with respect to contralateral and control, respectively, the affected side initiates feature motion at a shorter indentation distance by 61% and 50%, travels further by 15% and 9%, at a lower rate of 28% and 15%, and is stiffer by 40% and 57%. In an extended analysis including the spatial location of the 8 designated features, we report that in contrast to the contralateral and control muscles, the affected musculotendon unit does not strain measurably within the imaging window. These results confirm that chronic stroke-induced spasticity changes musculotendon unit passive mechanics, causing it to not strain under stretch. The mechanisms responsible for altered passive mechanics may lie within extracellular matrix fibrosis.
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20
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Park D, Cynn HS, Yi C, Choi WJ, Shim JH, Oh DW. Four-week training involving self-ankle mobilization with movement versus calf muscle stretching in patients with chronic stroke: a randomized controlled study. Top Stroke Rehabil 2019; 27:296-304. [PMID: 31742488 DOI: 10.1080/10749357.2019.1690831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: In self-ankle mobilization with movement (S-MWM) therapy, a strap can be utilized to stabilize the posterior glide of the talus during ankle dorsiflexion movements.Objectives: Our objective was to compare the effects of 4-week self-mobilization with movement (S-MWM) with those of calf muscle stretching (CMS) on ankle dorsiflexion passive range of motion (DF-PROM), gait parameters, and fall risk in patients with chronic stroke with limited ankle dorsiflexion.Methods: Participants were randomized into the S-MWM (n = 19) and CMS groups (n = 19). Both groups received conventional physiotherapy for 30 minutes per session. In addition, S-MWM and CMS techniques were performed 3 times per week for 4 weeks and were performed by the participants themselves. Ankle DF-PROM, gait parameters, and fall risk were measured after 4 weeks of training.Results: After 4 weeks of training, both groups showed significant improvement in all outcome measures (p < .05). Furthermore, ankle DF-PROM, gait parameters (gait speed, cadence, and stride lengths on both sides), and fall risk showed greater improvement in the S-MWM group than in the CMS group (p < .05).Conclusions: This study shows that S-MWM training combined with conventional physiotherapy improved ankle DF-PROM, gait parameters, and fall risk in patients with chronic stroke.
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Affiliation(s)
- Donghwan Park
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of South Korea
| | - Heon-Seock Cynn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of South Korea
| | - Chunghwi Yi
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of South Korea
| | - Woochol Joseph Choi
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Kangwon-do, Republic of South Korea
| | - Jae-Hun Shim
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan-si, Chungcheongnam-do, Republic of South Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju-si, Chungcheongbuk-do, Republic of South Korea
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21
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Noble S, Pearcey GEP, Quartly C, Zehr EP. Robot controlled, continuous passive movement of the ankle reduces spinal cord excitability in participants with spasticity: a pilot study. Exp Brain Res 2019; 237:3207-3220. [PMID: 31599345 PMCID: PMC6882765 DOI: 10.1007/s00221-019-05662-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/28/2019] [Indexed: 02/06/2023]
Abstract
Spasticity of the ankle reduces quality of life by impeding walking and other activities of daily living. Robot-driven continuous passive movement (CPM) is a strategy for lower limb spasticity management but effects on spasticity, walking ability and spinal cord excitability (SCE) are unknown. The objectives of this experiment were to evaluate (1) acute changes in SCE induced by 30 min of CPM at the ankle joint, in individuals without neurological impairment and those with lower limb spasticity; and, (2) the effects of 6 weeks of CPM training on SCE, spasticity and walking ability in those with lower limb spasticity. SCE was assessed using soleus Hoffmann (H-) reflexes, collected prior to and immediately after CPM for acute assessments, whereas a multiple baseline repeated measures design assessed changes following 18 CPM sessions. Spasticity and walking ability were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Twenty-one neurologically intact and nine participants with spasticity (various neurological conditions) were recruited. In the neurologically intact group, CPM caused bi-directional modulation of H-reflexes creating 'facilitation' and 'suppression' groups. In contrast, amongst participants with spasticity, acute CPM facilitated H-reflexes. After CPM training, H-reflex excitability on both the more-affected and less-affected sides was reduced; on the more affected side H@Thres, H@50 and H@100 all significantly decreased following CPM training by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. After training there were modest improvements in walking and clinical measures of spasticity for some participants. We conclude that CPM of the ankle can significantly alter SCE. The use of CPM in those with spasticity can provide a temporary period of improved walking, but efficacy of treatment remains unknown.
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Affiliation(s)
- Steven Noble
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada
| | - Caroline Quartly
- Collaborative Spasticity Program, Queen Alexandra Hospital, Vancouver Island Health Authority, Victoria, BC, Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, PO Box 3010 STN CSC, Victoria, BC, V8W 3P1, Canada. .,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC, Canada. .,Centre for Biomedical Research, University of Victoria, Victoria, BC, Canada. .,Division of Medical Sciences, University of Victoria, Victoria, BC, Canada. .,Zanshin Consulting Inc., Victoria, BC, Canada.
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Kim SL, Lee BH. The Effects of Posterior Talar Glide and Dorsiflexion of the Ankle Plus Mobilization with Movement on Balance and Gait Function in Patient with Chronic Stroke: A Randomized Controlled Trial. J Neurosci Rural Pract 2019; 9:61-67. [PMID: 29456346 PMCID: PMC5812162 DOI: 10.4103/jnrp.jnrp_382_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: This study was to evaluate the effects of weight-bearing-based mobilization with movement (WBBMWM) on balance and gait in stroke patients. Methods: Thirty stroke patients participated in this study. All individuals were randomly assigned to either WBMWM group (n = 15) or weight-bearing with placebo mobilization with movement group (control, n = 15). Individuals in the WBMWM group were trained for 10 glides of 5 sets a day, 5 times a week during 4 weeks. Furthermore, individuals in the control group were trained for 10 lunges of 5 sets a day, 5 times a week during 4 weeks. All individuals were measured weight-bearing lunge test (WBLT), static balance ability, timed up and go test (TUG), and dynamic gait index (DGI) in before and after intervention. Results: The result showed that WBBMWM group and control group had significantly increased in WBLT, postural sway speed, total postural sway path length with eyes open and closed, TUG and DGI (P < 0.05). In particular, the WBMWM group showed significantly greater improvement than control group in WBLT, static balance measures, TUG, and DGI (P < 0.05). Conclusion: Therefore, WBMWM improved ankle range of motion, balance, and gait in stroke patients. These results suggest that WBBMWM is feasible and suitable for individuals with a stroke.
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Affiliation(s)
- Sang-Lim Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul, Republic of Korea
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Park JH, Kim Y, Lee KJ, Yoon YS, Kang SH, Kim H, Park HS. Artificial Neural Network Learns Clinical Assessment of Spasticity in Modified Ashworth Scale. Arch Phys Med Rehabil 2019; 100:1907-1915. [PMID: 31009599 DOI: 10.1016/j.apmr.2019.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To propose an artificial intelligence (AI)-based decision-making rule in modified Ashworth scale (MAS) that draws maximum agreement from multiple human raters and to analyze how various biomechanical parameters affect scores in MAS. DESIGN Prospective observational study. SETTING Two university hospitals. PARTICIPANTS Hemiplegic adults with elbow flexor spasticity due to acquired brain injury (N=34). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Twenty-eight rehabilitation doctors and occupational therapists examined MAS of elbow flexors in 34 subjects with hemiplegia due to acquired brain injury while the MAS score and biomechanical data (ie, joint motion and resistance) were collected. Nine biomechanical parameters that quantify spastic response described by the joint motion and resistance were calculated. An AI algorithm (or artificial neural network) was trained to predict the MAS score from the parameters. Afterwards, the contribution of each parameter for determining MAS scores was analyzed. RESULTS The trained AI agreed with the human raters for the majority (82.2%, Cohen's kappa=0.743) of data. The MAS scores chosen by the AI and human raters showed a strong correlation (correlation coefficient=0.825). Each biomechanical parameter contributed differently to the different MAS scores. Overall, angle of catch, maximum stretching speed, and maximum resistance were the most relevant parameters that affected the AI decision. CONCLUSIONS AI can successfully learn clinical assessment of spasticity with good agreement with multiple human raters. In addition, we could analyze which factors of spastic response are considered important by the human raters in assessing spasticity by observing how AI learns the expert decision. It should be noted that few data were collected for MAS3; the results and analysis related to MAS3 therefore have limited supporting evidence.
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Affiliation(s)
- Jeong-Ho Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Yushin Kim
- Division of Health Administration and Healthcare, Cheongju University, Cheongju, Korea
| | - Kwang-Jae Lee
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Yong-Soon Yoon
- Department of Rehabilitation Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Si Hyun Kang
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Heesang Kim
- Department of Physical Medicine and Rehabilitation, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea.
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Pradines M, Ghedira M, Portero R, Masson I, Marciniak C, Hicklin D, Hutin E, Portero P, Gracies JM, Bayle N. Ultrasound Structural Changes in Triceps Surae After a 1-Year Daily Self-stretch Program: A Prospective Randomized Controlled Trial in Chronic Hemiparesis. Neurorehabil Neural Repair 2019; 33:245-259. [PMID: 30900512 DOI: 10.1177/1545968319829455] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The effects of long-term stretching (>6 months) in hemiparesis are unknown. This prospective, randomized, single-blind controlled trial compared changes in architectural and clinical parameters in plantar flexors of individuals with chronic hemiparesis following a 1-year guided self-stretch program, compared with conventional rehabilitation alone. METHODS Adults with chronic stroke-induced hemiparesis (time since lesion >1 year) were randomized into 1 of 2, 1-year rehabilitation programs: conventional therapy (CONV) supplemented with the Guided Self-rehabilitation Contract (GSC) program, or CONV alone. In the GSC group, specific lower limb muscles, including plantar flexors, were identified for a diary-based treatment utilizing daily, high-load, home self-stretching. Blinded assessments included (1) ultrasonographic measurements of soleus and medial gastrocnemius (MG) fascicle length and thickness, with change in soleus fascicle length as primary outcome; (2) maximum passive muscle extensibility (XV1, Tardieu Scale); (3) 10-m maximal barefoot ambulation speed. RESULTS In all, 23 individuals (10 women; mean age [SD], 56 [±12] years; time since lesion, 9 [±8] years) were randomized into either the CONV (n = 11) or GSC (n = 12) group. After 1 year, all significant between-group differences favored the GSC group: soleus fascicle length, +18.1mm [9.3; 29.9]; MG fascicle length, +6.3mm [3.5; 9.1]; soleus thickness, +4.8mm [3.0; 7.7]; XV1 soleus, +4.1° [3.1; 7.2]; XV1 gastrocnemius, +7.0° [2.1; 11.9]; and ambulation speed, +0.07m/s [+0.02; +0.16]. CONCLUSIONS In chronic hemiparesis, daily self-stretch of the soleus and gastrocnemius over 1 year using GSC combined with conventional rehabilitation increased muscle fascicle length, extensibility, and ambulation speed more than conventional rehabilitation alone.
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Affiliation(s)
- Maud Pradines
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Mouna Ghedira
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Raphaël Portero
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France
| | - Ingrid Masson
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France
| | - Christina Marciniak
- 3 Northwestern University Feinberg School of Medicine, and the Shirley Ryan Ability Lab, Chicago, IL, USA
| | - Dawn Hicklin
- 4 Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Emilie Hutin
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Pierre Portero
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France
| | - Jean-Michel Gracies
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Nicolas Bayle
- 1 EA 7377 BIOTN, Université Paris-Est Créteil (UPEC), France.,2 Hôpitaux Universitaires Henri Mondor, Créteil, France
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Le Sant G, Nordez A, Hug F, Andrade R, Lecharte T, McNair PJ, Gross R. Effects of stroke injury on the shear modulus of the lower leg muscle during passive dorsiflexion. J Appl Physiol (1985) 2019; 126:11-22. [DOI: 10.1152/japplphysiol.00968.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Contractures are common complications of a stroke. The spatial location of the increased stiffness among plantar flexors and its variability among survivors remain unknown. This study assessed the mechanical properties of the lower leg muscles in stroke survivors during passive dorsiflexions. Stiffness was estimated through the measurement of the shear modulus. Two experiments were independently conducted, in which participants lay supine: with the knee extended ( experiment 1, n = 13 stroke survivors and n = 13 controls), or with the knee flexed at 90° ( experiment 2, n = 14 stroke survivors and n = 14 controls). The shear modulus of plantar flexors [gastrocnemius medialis (three locations), gastrocnemius lateralis (three locations), soleus (two locations), flexor digitorum longus, flexor hallucis longus), peroneus longus] and dorsiflexors (tibialis anterior and extensor digitorum longus) was measured using ultrasound shear wave elastography during passive dorsiflexions (2°/s). At the same ankle angle, stroke survivors displayed higher shear modulus than controls for gastrocnemius medialis and gastrocnemius lateralis (knee extended) and soleus (knee flexed). Very low shear modulus was found for the other muscles. The adjustment for muscle slack angle suggested that the increased shear modulus was arising from consequences of contractures. The stiffness distribution between muscles was consistent across participants with the highest shear modulus reported for the most distal regions of gastrocnemius medialis (knee extended) and soleus (knee flexed). These results provide a better appreciation of stiffness locations among plantar flexors of stroke survivors and can provide evidence for the implementation of clinical trials to evaluate targeted interventions applied on these specific muscle regions.NEW & NOTEWORTHY The shear modulus of 13 muscle regions was assessed in stroke patients using elastography. When compared with controls, shear modulus was increased in the gastrocnemius muscle (GM) when the knee was extended and in the soleus (SOL) when the knee was flexed. The distal regions of GM and SOL were the most affected. These changes were consistent in all the stroke patients, suggesting that the regions are a potential source of the increase in joint stiffness.
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Affiliation(s)
- Guillaume Le Sant
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- School of Physiotherapy, Institut Régional de Formation aux Métiers de Rééducation et de Réadaptation Pays de la Loire, Nantes, France
| | - Antoine Nordez
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - François Hug
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Australia
- Institut Universitaire de France, Paris, France
| | - Ricardo Andrade
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- Universidade de Lisboa, Faculdade de Motricdade Humana, Centro Interdisciplinar de Performance Humana, Lisbon, Portugal
| | - Thomas Lecharte
- School of Physiotherapy, Institut Régional de Formation aux Métiers de Rééducation et de Réadaptation Pays de la Loire, Nantes, France
| | - Peter J. McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Raphaël Gross
- University of Nantes, Laboratory “Movement, Interactions, Performance” (EA 4334), Faculty of Sport Sciences, Nantes, France
- Gait Analysis Laboratory, Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
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Wu YN, Park HS, Chen JJ, Ren Y, Roth EJ, Zhang LQ. Position as Well as Velocity Dependence of Spasticity-Four-Dimensional Characterizations of Catch Angle. Front Neurol 2018; 9:863. [PMID: 30416478 PMCID: PMC6212511 DOI: 10.3389/fneur.2018.00863] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 11/26/2022] Open
Abstract
We investigated the muscle alterations related to spasticity in stroke quantitatively using a portable manual spasticity evaluator. Methods: Quantitative neuro-mechanical evaluations under controlled passive elbow stretches in stroke survivors and healthy controls were performed in a research laboratory of a rehabilitation hospital. Twelve stroke survivors and nine healthy controls participated in the study. Spasticity and catch angle were evaluated at 90°/s and 270°/s with the velocities controlled through real-time audiovisual feedback. The elbow range of motion (ROM), stiffness, and energy loss were determined at a slow velocity of 30°/s. Four-dimensional measures including joint position, torque, velocity and torque change rate were analyzed jointly to determine the catch angle. Results: The catch angle was dependent on the stretch velocity and occurred significantly later with increasing velocity (p < 0.001), indicating position dependence of spasticity. The higher resistance felt by the examiner at the higher velocity was also due to more extreme joint position (joint angle) since the spastic joint was moved significantly further to a stiffer elbow position with the higher velocity. Stroke survivors showed smaller ROM (p < 0.001), higher stiffness (p < 0.001), and larger energy loss (p = 0.005). Compared to the controls, stroke survivors showed increased reflex excitability with higher reflex-mediated torque (p < 0.001) and at higher velocities (p = 0.02). Conclusion: Velocity dependence of spasticity is partially due to joint angle position dependence with the joint moved further (to a stiffer position where higher resistance was felt) at a higher velocity. The “4-dimensional characterization” including the joint angle, velocity, torque, and torque change rate provides a systematic tool to characterize catch angle and spasticity quantitatively.
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Affiliation(s)
- Yi-Ning Wu
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korean Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jia-Jin Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Yupeng Ren
- Rehabtek LLC, Glenview, IL, United States
| | - Elliot J Roth
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| | - Li-Qun Zhang
- Department of Physical Therapy and Rehabilitation Science, Department of Orthopaedics, University of Maryland, Baltimore, MD, United States.,Department of Bioengineering, University of Maryland, College Park, MD, United States
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Yoo D, Son Y, Kim DH, Seo KH, Lee BC. Technology-Assisted Ankle Rehabilitation Improves Balance and Gait Performance in Stroke Survivors: A Randomized Controlled Study With 1-Month Follow-Up. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2315-2323. [PMID: 30418882 DOI: 10.1109/tnsre.2018.2879783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Many stroke survivors have limited ankle range of motion (ROM) caused by weak dorsiflexors and stiff plantarflexors. Passive ankle stretching exercises with physical therapists or a stretching board are usually recommended, but these treatments have some limitations (e.g., cost and availability of physical therapists). In this paper, we assessed the results of ankle stretching exercises delivered by a robotic ankle stretching system called motorized ankle stretcher (MAS) that we developed or by a stretching board on ankle ROM, balance control, and gait performance. The 16 stroke survivors were randomly assigned to an intervention group (IG) or a control group (CG) and participated in seven sessions of dorsiflexion stretching exercises for three-and-a-half consecutive weeks. Laboratory assessments included pre-assessment (baseline at the beginning of the first exercise session), post-assessment (at the end of the seventh exercise session), and retention assessment (one month after the seventh exercise session). All assessments included ankle ROM for the affected side, static/dynamic balance control with a sensory organization test (SOT), walking speed, walking cadence, and step length for the affected and unaffected sides. During seven sessions of ankle stretching exercises, the IG performed them using the MAS, and the CG used a stretching board. The IG significantly improved ankle ROM, SOT scores (i.e., static/dynamic balance control), walking speeds, walking cadences, and step lengths for the unaffected side after completing the seven exercise sessions of ankle stretching exercises and maintained the enhancements at the retention assessment. The CG did not significantly improve across the majority of outcome measures except for the SOT scores between the pre-assessment and retention assessment. Future work will investigate the ideal intensity, frequency, and duration of exercising with the MAS. Our research on technology-assisted ankle rehabilitation, which can ascertain the level of persistent improvement, long-term performance retention, and carry-over effects in stroke survivors, can be used to inform future designs.
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Park D, Lee JH, Kang TW, Cynn HS. Effects of a 4-Week Self-Ankle Mobilization with Movement Intervention on Ankle Passive Range of Motion, Balance, Gait, and Activities of Daily Living in Patients with Chronic Stroke: A Randomized Controlled Study. J Stroke Cerebrovasc Dis 2018; 27:3451-3459. [PMID: 30193809 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/14/2018] [Accepted: 08/05/2018] [Indexed: 12/26/2022] Open
Abstract
GOAL To compare the effects of a 4-week self-ankle mobilization with movement training program with those of self-ankle mobilization with movement with a 10° inclined board in patients with chronic stroke. MATERIALS AND METHODS A randomized controlled assessor-blind trial was conducted. The patients were randomized into 2 arms. Subjects were 28 chronic stroke patients with hemiplegia. Both arms attended standard rehabilitation therapy for 30 minutes per session. In addition, self-ankle mobilization with movement and self-ankle mobilization with movement with a 10° inclined board trainings were performed 3 times per week for 4 weeks. Ankle dorsiflexion passive range of motion, static balance ability, Berg balance scale, gait parameters (walking speed, cadence, and step length), and activities of daily living were used to assess changes in motor function after training. FINDINGS After 4 weeks of training, all dependent variables were significantly improved in both arms as compared with their baseline values. Furthermore, relative to the self-ankle mobilization with movement arm, the self-ankle mobilization with movement with a 10° inclined board arm demonstrated significantly improved ankle dorsiflexion passive range of motion, static balance ability, gait speed, cadence, and affected-side step length. CONCLUSIONS Our results support the hypothesis that self-ankle mobilization with movement with a 10° inclined board combined with standard rehabilitation was superior to self-ankle mobilization with movement combined with standard rehabilitation with respect to the improvement in motor function in the patients with chronic stroke.
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Affiliation(s)
- Donghwan Park
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Ji-Hyun Lee
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea
| | - Heon-Seock Cynn
- Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Gangwon-do, Republic of Korea.
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Park D, Lee JH, Kang TW, Cynn HS. Immediate effects of talus-stabilizing taping on balance and gait parameters in patients with chronic stroke: a cross-sectional study. Top Stroke Rehabil 2018; 25:417-423. [PMID: 29717946 DOI: 10.1080/10749357.2018.1466972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Talus-stabilizing taping (TST) may improve ankle range of motion and gait performance by providing a posterior-inferior talar glide in a closed-chain dorsiflexion position. OBJECTIVES This study aimed to investigate the immediate effects of TST on balance and gait parameters in patients with chronic stroke. METHODS Twenty post-stroke patients participated in this study. Each participant performed tests under three conditions (TST, barefoot, and conventional ankle-foot orthosis [AFO]), in random order. Before testing, the patients walked for 10 min under the three conditions, followed by a 5 min rest period. The outcome measures were static balance ability (SBA), timed up-and-go (TUG) test results, and gait parameters evaluated using a 6-m-long gait mat. One-way repeated measures analysis of variance was used to determine the difference in balance and gait parameters under the three conditions. RESULTS SBA more significantly improved in the TST condition than in the barefoot condition. SBA more significantly improved in the conventional AFO condition than in the barefoot condition. The TUG test results more significantly improved in the TST condition than in the conventional AFO and barefoot conditions. Walking speed, cadence, and affected side and unaffected side step and stride lengths more significantly improved in the TST condition than in the conventional AFO and barefoot conditions. CONCLUSIONS This study used a cross-sectional method and demonstrated that TST improves SBA, TUG, gait speed, cadence, step length, and stride length in patients with chronic stroke.
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Affiliation(s)
- Donghwan Park
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
| | - Ji-Hyun Lee
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
| | - Tae-Woo Kang
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
| | - Heon-Seock Cynn
- a Department of Physical Therapy, Graduate School , Yonsei University , Wonju , Republic of South Korea
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Ghasemi E, Khademi-Kalantari K, Khalkhali-Zavieh M, Rezasoltani A, Ghasemi M, Akbarzadeh Baghban A, Ghasemi M. The Effect of Functional Stretching Exercises on Neural and Mechanical Properties of the Spastic Medial Gastrocnemius Muscle in Patients with Chronic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2018; 27:1733-1742. [PMID: 29706442 DOI: 10.1016/j.jstrokecerebrovasdis.2018.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/08/2018] [Accepted: 01/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following spasticity, neural and mechanical changes of the paretic muscle often occur, which affect the muscle function. The aim of this study was to investigate the effect of functional stretching exercises on neural and mechanical properties of the spastic muscle in patients with stroke. MATERIALS AND METHODS This study was a single-blinded, randomized control trial. Forty five patients with stroke (experimental group: n = 30; control group: n = 15) participated in this study. Subjects in the experimental group participated in a functional stretching program 3 times a week for 4 weeks. Subjects in both groups were evaluated before the training, at the end of training, and then during a 2-month follow-up. Neural properties, including H-reflex latency and Hmax/Mmax ratio, were acquired. Mechanical properties, including fascicle length, pennation angle, and muscle thickness in the spastic medial gastrocnemius muscle, were evaluated. Repeated measure analysis of variance was used in the analysis. RESULTS Time by group interaction in the pennation angle (P = .006), and in muscle thickness (P = .030) was significant. The results indicated that the H-reflex latency (P = .006), pennation angle (P < .001), and muscle thickness (P = .001) were altered after stretching training program and these changes were at significant level after 2-month follow-up. CONCLUSION The results indicated that the use of functional stretching exercises can cause significant differences in neural and mechanical properties of spastic medial gastrocnemius muscle in patients with chronic stroke.
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Affiliation(s)
- Ehsan Ghasemi
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Khademi-Kalantari
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Minoo Khalkhali-Zavieh
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Rezasoltani
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehri Ghasemi
- Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology & Isfahan Neurosciences Research Center, Faculty of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Low FZ, Lim JH, Yeow CH. Design, characterisation and evaluation of a soft robotic sock device on healthy subjects for assisted ankle rehabilitation. J Med Eng Technol 2017; 42:26-34. [DOI: 10.1080/03091902.2017.1411985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Fan-Zhe Low
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Jeong Hoon Lim
- Department of Medicine, National University Hospital, Singapore
| | - Chen-Hua Yeow
- Department of Biomedical Engineering, National University of Singapore, Singapore
- Singapore Institute for Neurotechnology and Advanced Robotics Center, National University of Singapore, Singapore
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Hassan M, Yagi K, Hsiao K, Mochiyama H, Suzuki K. Tarsusmeter: Development of a wearable device for ankle joint impedance estimation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3293-3296. [PMID: 29060601 DOI: 10.1109/embc.2017.8037560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present the development and basic evaluation of a new wearable device for estimation of ankle joint impedance called Tarsusmeter. The device is intended for application with persons with locomotion disabilities to quantify the ankle joint impedance, especially in cases of spasticity where the joint's impedance is expected to differ significantly from healthy persons. The lack of a simple and light weight solution to provide objective evaluation of ankle joint impedance motivates the design criteria of this device to be as such. The target application is also to quantify variable stiffness actuator based orthosis in-vivo. Thus the form factor avoids overlap with custom shapes of such orthosis. The paper presents the mechanical design of the device, physical simulations to characterize the device-leg system, the used algorithm for impedance parameter estimation, and preliminary testing of the device.
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Ren Y, Wu YN, Yang CY, Xu T, Harvey RL, Zhang LQ. Developing a Wearable Ankle Rehabilitation Robotic Device for in-Bed Acute Stroke Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2017; 25:589-596. [DOI: 10.1109/tnsre.2016.2584003] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhang LQ, Son J, Park HS, Kang SH, Lee Y, Ren Y. Changes of Shoulder, Elbow, and Wrist Stiffness Matrix Post Stroke. IEEE Trans Neural Syst Rehabil Eng 2017; 25:844-851. [PMID: 28541901 DOI: 10.1109/tnsre.2017.2707238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stroke affects multiple joints in the arm with stereotypical patterns of arm deformity involving the shoulder, elbow, wrist, and hand and with disrupted coordination of multiple joints in active movements. However, there is a lack of systematic methods to evaluate multi-joints and multi-degree of freedoms (DOF) neuro-mechanical changes, especially for complex systems with three or more joints/DOFs involved. This paper used a novel systematic method to characterize dynamics and control of the shoulder, elbow, and wrist of the human arm individually and simultaneously, including the couplings across the multiple joints during controlled movements. A novel method was developed to decompose the complex system into manageable single-joint level for more reliable characterizations. The method was used in clinical studies to characterize the multi-joint changes associated with spastic impaired arm of 11 patients post stroke and 12 healthy controls. It was found that stroke survivors showed not only increased stiffness at the individual joints locally but also significantly higher couplings across the joints. The relative increases in couplings are often higher than that of the local joint stiffness. The multi-joint characterization provided a tool to characterize impairment of individual patients, which would allow more focused impairment-specific treatment. In general, the decomposition method can be used for even more complex systems, making characterization of intractable system dynamics of three or more joints/DOFs manageable.
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Lee Y, Chen K, Ren Y, Son J, Cohen BA, Sliwa JA, Zhang LQ. Robot-guided ankle sensorimotor rehabilitation of patients with multiple sclerosis. Mult Scler Relat Disord 2016; 11:65-70. [PMID: 28104260 DOI: 10.1016/j.msard.2016.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/22/2016] [Accepted: 12/11/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with multiple sclerosis (MS) often develop symptoms including muscle weakness, spasticity, imbalance, and sensory loss in the lower limbs, especially at the ankle, which result in impaired balance and locomotion and increased risk of falls. Rehabilitation strategies that improve ankle function may improve mobility and safety of ambulation in patients with MS. This pilot study investigated effectiveness of a robot-guided ankle passive-active movement training in reducing motor and sensory impairments and improving balance and gait functions. METHODS Seven patients with MS participated in combined passive stretching and active movement training using an ankle rehabilitation robot. Six of the patients finished robotic training 3 sessions per week over 6 weeks for a total of 18 sessions. Biomechanical and clinical outcome evaluations were done before and after the 6-week treatment, and at a follow-up six weeks afterwards. RESULTS After six-week ankle sensorimotor training, there were increases in active range of motion in dorsiflexion, dorsiflexor and plantar flexor muscle strength, and balance and locomotion (p<0.05). Proprioception acuity showed a trend of improvement. Improvements in four biomechanical outcome measures and two of the clinical outcome measures were maintained at the 6-week follow-up. The study showed the six-week training duration was appropriate to see improvement of range of motion and strength for MS patients with ankle impairment. CONCLUSION Robot-guided ankle training is potentially a useful therapeutic intervention to improve mobility in patients with MS.
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Affiliation(s)
- Yunju Lee
- Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, IL 60611, United States
| | - Kai Chen
- Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, IL 60611, United States
| | - Yupeng Ren
- Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, IL 60611, United States
| | - Jongsang Son
- Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, IL 60611, United States
| | - Bruce A Cohen
- Northwestern University, 710 N Lake Shore Drive, Chicago, IL 60611, United States
| | - James A Sliwa
- Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, IL 60611, United States; Northwestern University, 710 N Lake Shore Drive, Chicago, IL 60611, United States
| | - Li-Qun Zhang
- Rehabilitation Institute of Chicago, 345 E Superior Street, Chicago, IL 60611, United States; Northwestern University, 710 N Lake Shore Drive, Chicago, IL 60611, United States; NorthShore University HealthSystem, 2650 Ridge Rd., Evanston, IL 60201, United States.
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Effects of Talocrural Mobilization with Movement on Ankle Strength, Mobility, and Weight-Bearing Ability in Hemiplegic Patients with Chronic Stroke: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2016; 26:169-176. [PMID: 27765557 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/25/2016] [Accepted: 09/03/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In general, adequate movement of the ankle joint is known to play an important role in functional activities. Stroke survivors frequently have limited range of motion of the ankle, leading to dysfunctional weight transfer toward the paretic lower limb during standing or gait. The purpose of this study was to investigate the effects of talocrural mobilization with movement (MWM) on ankle strength, dorsiflexion passive range of motion (DF-PROM), and weight-bearing ability on the paretic limb during standing or gait in stroke patients with limited ankle dorsiflexion. METHODS Twenty-six participants with chronic hemiplegia (>6 months post stroke) were divided into 2 groups: MWM group (n = 13) and control group (n = 13). Both groups attended conventional physiotherapy sessions 3 times a week for 5 weeks. Additionally, the MWM group underwent talocrural MWM 3 times a week for 5 weeks. Isokinetic ankle strength, DF-PROM, and weight-bearing ability measures included the limit of stability (LOS); gait parameters were evaluated before and after interventions. RESULTS Plantarflexors peak torque and DF-PROM significantly increased in the MWM group. In addition, forward and forward-paretic direction LOS significantly increased in the MWM group. Paretic direction LOS, single-limb support phase of the paretic limb significantly increased and double limb support phase significantly decreased within the MWM group. CONCLUSIONS This study demonstrates that talocrural MWM has an augmented effect on ankle strength, mobility, and weight-bearing ability in chronic stroke patients with limited ankle motion when added to conventional therapy.
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Kim HS, Chung SC, Choi MH, Gim SY, Kim WR, Tack GR, Lim DW, Chun SK, Kim JW, Mun KR. Primary and secondary gait deviations of stroke survivors and their association with gait performance. J Phys Ther Sci 2016; 28:2634-2640. [PMID: 27799710 PMCID: PMC5080192 DOI: 10.1589/jpts.28.2634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022] Open
Abstract
[Purpose] Stroke survivors exhibit abnormal pelvic motion and significantly deteriorated
gait performance. Although the gait of stroke survivors has been evaluated at the primary
level pertaining to ankle, knee, and hip motions, secondary deviations involving the
pelvic motions are strongly related to the primary level. Therefore, the aim of this study
was to identify the kinematic differences of the primary and secondary joints and to
identify mechanism differences that alter the gait performance of stroke survivors.
[Subjects and Methods] Five healthy subjects and five stroke survivors were recruited. All
the subjects were instructed to walk at a self-selected speed. The joint kinematics and
gait parameters were calculated. [Results] For the stroke survivors, the range of motion
of the primary-joint motions were significantly reduced, and the secondary-joint motions
were significantly increased. Additionally, for the healthy subjects, the primary joint
kinematics were the main factors ensuring gait performance, whereas for the stoke
survivors, the secondary-joint motions were the main factors. [Conclusion] The results
indicate that while increasing the range of motion of primary-joint movements is the main
target to achieve, there is a strong need to constrain and support pelvic motions in order
to improve the outcome of gait rehabilitation.
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Affiliation(s)
- Hyung-Sik Kim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Soon-Cheol Chung
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Mi-Hyun Choi
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Seon-Young Gim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Woo-Ram Kim
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Gye-Rae Tack
- Department of Biomedical Engineering, BK21+ Research Institute of Biomedical Engineering, College of Biomedical and Health Science, Konkuk University, Republic of Korea
| | - Dae-Woon Lim
- Department of Information and Communication Engineering, Dongguk University, Republic of Korea
| | - Sung-Kuk Chun
- Imaging Media Research Center, Korea Institute of Science and Technology, Republic of Korea
| | - Jin-Wook Kim
- Imaging Media Research Center, Korea Institute of Science and Technology, Republic of Korea
| | - Kyung-Ryoul Mun
- Imaging Media Research Center, Korea Institute of Science and Technology, Republic of Korea
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Sousa ASP, Santos R, Silva A. Ankle Intrinsic Stiffness in Subcortical Poststroke Subjects. J Mot Behav 2016; 49:265-272. [PMID: 27588813 DOI: 10.1080/00222895.2016.1191421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The authors' purpose was to evaluate bilateral ankle intrinsic stiffness in subcortical poststroke subjects. Ten subcortical poststroke subjects and 10 healthy controls participated in this study. The ankle passive stiffness at 3 different speeds and the electromyographic activity of the soleus, the gastrocnemius, and the tibialis anterior muscles of poststroke contralesional (CONTRA) and ipsilesional (IPSI) limbs and of one limb of healthy subjects were assessed. Ankle electromyographic activity was collected to ensure that reflexive or voluntary muscle activity was not being elicited during the passive movements. A significant interaction was observed between the effects of the limb (IPSI vs. CONTRA vs. control) and ankle position, F(4, 28) = 3.285, p = .025, and between the effects of the limb and the velocity of stretch, F(2, 14) = 4.209, p = .037. While increased intrinsic stiffness was observed in the CONTRA limb of poststroke subjects at ankle neutral position when the passive stretch was applied with a velocity of 1°/s (p = .021), the IPSI limb of poststroke subjects presented increased stiffness at 20º of plantar flexion when the stretch was applied with a velocity of 5°/s (p = .009) when compared to healthy group. Subcortical poststroke subjects present increased intrinsic stiffness in both the CONTRA and IPSI limbs in specific ankle amplitudes.
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Affiliation(s)
- Andreia S P Sousa
- a Centro de Estudos de Movimento e Atividade Humana , Área Científica de Fisioterapia, Instituto Politécnico do Porto, Escola Superior de Saúde do Porto , Vila Nova de Gaia , Portugal
| | - Rubim Santos
- b Centro de Estudos de Movimento e Atividade Humana , Área Científica de Física, Escola Superior de Saúde do Porto , Vila Nova de Gaia , Portugal
| | - Augusta Silva
- a Centro de Estudos de Movimento e Atividade Humana , Área Científica de Fisioterapia, Instituto Politécnico do Porto, Escola Superior de Saúde do Porto , Vila Nova de Gaia , Portugal
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Maggioni S, Melendez-Calderon A, van Asseldonk E, Klamroth-Marganska V, Lünenburger L, Riener R, van der Kooij H. Robot-aided assessment of lower extremity functions: a review. J Neuroeng Rehabil 2016; 13:72. [PMID: 27485106 PMCID: PMC4969661 DOI: 10.1186/s12984-016-0180-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/21/2016] [Indexed: 01/01/2023] Open
Abstract
The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice.
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Affiliation(s)
- Serena Maggioni
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland.
- Hocoma AG, Volketswil, Switzerland.
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland.
| | - Alejandro Melendez-Calderon
- Hocoma AG, Volketswil, Switzerland
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edwin van Asseldonk
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | | | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Abstract
Understanding the passive or nonpassive behavior of the neuromuscular system is important to design and control robots that physically interact with humans, since it provides quantitative information to secure coupled stability while maximizing performance. This has become more important than ever apace with the increasing demand for robotic technologies in neurorehabilitation. This paper presents a quantitative characterization of passive and nonpassive behavior of the ankle of young healthy subjects, which provides a baseline for future studies in persons with neurological impairments and information for future developments of rehabilitation robots, such as exoskeletal devices and powered prostheses. Measurements using a wearable ankle robot actuating 2 degrees-of-freedom of the ankle combined with curl analysis and passivity analysis enabled characterization of both quasi-static and steady-state dynamic behavior of the ankle, unavailable from single DOF studies. Despite active neuromuscular control over a wide range of muscle activation, in young healthy subjects passive or dissipative ankle behavior predominated.
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KUNG PINCHENG, LIN CHOUCHINGK, CHEN SHUMIN, JU MINGSHAUNG. CONTROL OF FOREARM MODULE IN UPPER-LIMB REHABILITATION ROBOT FOR REDUCTION AND BIOMECHANICAL ASSESSMENT OF PRONATOR HYPERTONIA OF STROKE PATIENTS. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spastic hypertonia causes loss of range of motion (ROM) and contractures in patients with post-stroke hemiparesis. The pronation/supination of the forearm is an essential functional movement in daily activities. We developed a special module for a shoulder-elbow rehabilitation robot for the reduction and biomechanical assessment of pronator/supinator hypertonia of the forearm. The module consisted of a rotational drum driven by an AC servo motor and equipped with an encoder and a custom-made torque sensor. By properly switching the control algorithm between position control and torque control, a hybrid controller able to mimic a therapist’s manual stretching movements was designed. Nine stroke patients were recruited to validate the functions of the module. The results showed that the affected forearms had significant increases in the ROM after five cycles of stretching. Both the passive ROM and the average stiffness were highly correlated to the spasticity of the forearm flexor muscles as measured using the Modified Ashworth Scale (MAS). With the custom-made module and controller, this upper-limb rehabilitation robot may be able to aid physical therapists to reduce hypertonia and quantify biomechanical properties of the muscles for forearm rotation in stroke patients.
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Affiliation(s)
- PIN-CHENG KUNG
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
| | - CHOU-CHING K. LIN
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
- Department of Neurology, University Hospital, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
| | - SHU-MIN CHEN
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
- Department of Physical Medicine and Rehabilitation, University Hospital, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
| | - MING-SHAUNG JU
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
- Department of Mechanical Engineering, National Cheng Kung University, Tainan, Taiwan 701, Taiwan
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42
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Chen K, Wu YN, Ren Y, Liu L, Gaebler-Spira D, Tankard K, Lee J, Song W, Wang M, Zhang LQ. Home-Based Versus Laboratory-Based Robotic Ankle Training for Children With Cerebral Palsy: A Pilot Randomized Comparative Trial. Arch Phys Med Rehabil 2016; 97:1237-43. [PMID: 26903143 DOI: 10.1016/j.apmr.2016.01.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/28/2016] [Accepted: 01/31/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the outcomes of home-based robot-guided therapy and compare it to laboratory-based robot-guided therapy for the treatment of impaired ankles in children with cerebral palsy. DESIGN A randomized comparative trial design comparing a home-based training group and a laboratory-based training group. SETTING Home versus laboratory within a research hospital. PARTICIPANTS Children (N=41) with cerebral palsy who were at Gross Motor Function Classification System level I, II, or III were randomly assigned to 2 groups. Children in home-based and laboratory-based groups were 8.7±2.8 (n=23) and 10.7±6.0 (n=18) years old, respectively. INTERVENTIONS Six-week combined passive stretching and active movement intervention of impaired ankle in a laboratory or home environment using a portable rehabilitation robot. MAIN OUTCOME MEASURES Active dorsiflexion range of motion (as the primary outcome), mobility (6-minute walk test and timed Up and Go test), balance (Pediatric Balance Scale), Selective Motor Control Assessment of the Lower Extremity, Modified Ashworth Scale (MAS) for spasticity, passive range of motion (PROM), strength, and joint stiffness. RESULTS Significant improvements were found for the home-based group in all biomechanical outcome measures except for PROM and all clinical outcome measures except the MAS. The laboratory-based group also showed significant improvements in all the biomechanical outcome measures and all clinical outcome measures except the MAS. There were no significant differences in the outcome measures between the 2 groups. CONCLUSIONS These findings suggest that the translation of repetitive, goal-directed, biofeedback training through motivating games from the laboratory to the home environment is feasible. The benefits of home-based robot-guided therapy were similar to those of laboratory-based robot-guided therapy.
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Affiliation(s)
- Kai Chen
- Rehabilitation Institute of Chicago, Chicago, Illinois; Northwestern University, Chicago, Illinois
| | - Yi-Ning Wu
- University of Massachusetts Lowell, Lowell, Massachusetts
| | - Yupeng Ren
- Rehabilitation Institute of Chicago, Chicago, Illinois
| | - Lin Liu
- Rehabilitation Institute of Chicago, Chicago, Illinois; Xuanwu Hospital, Beijing, China
| | - Deborah Gaebler-Spira
- Rehabilitation Institute of Chicago, Chicago, Illinois; Northwestern University, Chicago, Illinois
| | - Kelly Tankard
- Rehabilitation Institute of Chicago, Chicago, Illinois; University of Kansas School of Medicine, Kansas City, Kansas
| | - Julia Lee
- Northwestern University, Chicago, Illinois
| | | | | | - Li-Qun Zhang
- Rehabilitation Institute of Chicago, Chicago, Illinois; Northwestern University, Chicago, Illinois.
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Low FZ, Tan HH, Lim JH, Yeow CH. Development of a Soft Pneumatic Sock for Robot-Assisted Ankle Exercise. J Med Device 2016. [DOI: 10.1115/1.4032616] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Deep vein thrombosis (DVT) is a severe medical condition that affects many patients around the world, where one of the main causes is commonly associated with prolonged immobilization. Current mechanical prophylaxis systems, such as the compression stockings and intermittent pneumatic compression devices, have yet to show strong efficacy in preventing DVT. The current study aimed to develop a soft pneumatic sock prototype that uses soft extension pneumatic actuators to provide assisted ankle dorsiflexion–plantarflexion motion, so as to prevent the occurrence of DVT. The prototype was evaluated for its efficacy to provide the required dorsiflexion–plantarflexion motion by donning and actuating the prototype on simulated ankle–foot models with various ankle joint stiffness values. Our results showed that the soft extension actuators in the sock prototype provided controllable assisted ankle plantarflexion through actuator extension and ankle dorsiflexion through actuator contraction, where in our study, the actuations extended to 129.9–146.8% of its original length. Furthermore, the sock was able to achieve consistent range of motion at the simulated ankle joint across different joint stiffness values (range of motion: 27.5 ± 6.0 deg). This study demonstrated the feasibility of using soft extension pneumatic actuators to provide robot-assisted ankle dorsiflexion–plantarflexion motion, which will act as an adjunct to physiotherapists to optimize therapy time for bedridden patients and therefore may reduce the risk of developing DVT.
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Affiliation(s)
- Fan-Zhe Low
- Department of Biomedical Engineering, National University of Singapore, Block E4, #04-08, 4 Engineering Drive 3, Singapore 117583, Singapore e-mail:
| | - Hong Han Tan
- Department of Biomedical Engineering, National University of Singapore, Block E4, #04-08, 4 Engineering Drive 3, Singapore 117583, Singapore e-mail:
| | - Jeong Hoon Lim
- Department of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore e-mail:
| | - Chen-Hua Yeow
- Department of Biomedical Engineering, National University of Singapore, Block E4, #04-08, 4 Engineering Drive 3, Singapore 117583, Singapore e-mail:
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Time-Varying Ankle Mechanical Impedance During Human Locomotion. IEEE Trans Neural Syst Rehabil Eng 2015; 23:755-64. [DOI: 10.1109/tnsre.2014.2346927] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lee H, Krebs HI, Hogan N. Multivariable dynamic ankle mechanical impedance with active muscles. IEEE Trans Neural Syst Rehabil Eng 2015; 22:971-81. [PMID: 25203497 DOI: 10.1109/tnsre.2014.2328235] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Multivariable dynamic ankle mechanical impedance in two coupled degrees-of-freedom (DOFs) was quantified when muscles were active. Measurements were performed at five different target activation levels of tibialis anterior and soleus, from 10% to 30% of maximum voluntary contraction (MVC) with increments of 5% MVC. Interestingly, several ankle behaviors characterized in our previous study of the relaxed ankle were observed with muscles active: ankle mechanical impedance in joint coordinates showed responses largely consistent with a second-order system consisting of inertia, viscosity, and stiffness; stiffness was greater in the sagittal plane than in the frontal plane at all activation conditions for all subjects; and the coupling between dorsiflexion-plantarflexion and inversion-eversion was small-the two DOF measurements were well explained by a strictly diagonal impedance matrix. In general, ankle stiffness increased linearly with muscle activation in all directions in the 2-D space formed by the sagittal and frontal planes, but more in the sagittal than in the frontal plane, resulting in an accentuated "peanut shape." This characterization of young healthy subjects' ankle mechanical impedance with active muscles will serve as a baseline to investigate pathophysiological ankle behaviors of biomechanically and/or neurologically impaired patients.
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Zhao H, Ren Y, Roth EJ, Harvey RL, Zhang LQ. Concurrent deficits of soleus and gastrocnemius muscle fascicles and Achilles tendon post stroke. J Appl Physiol (1985) 2015; 118:863-71. [PMID: 25663670 DOI: 10.1152/japplphysiol.00226.2014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 02/04/2015] [Indexed: 11/22/2022] Open
Abstract
Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomechanical measurements. Biomechanical properties of the Achilles tendon including the length, cross-sectional area (CSA), stiffness, and Young's modulus were evaluated, together with calf muscle biomechanical properties. Gastrocnemius and SOL contributions were separated using flexed and extended knee positions. The impaired side showed decreased fascicle length (GM: 6%, P = 0.002 and SOL: 9%, P = 0.03, at full knee extension and 0° ankle dorsiflexion) and increased fascicular stiffness (GM: 64%, P = 0.005 and SOL: 19%, P = 0.012, at a common 50 N force level). In contrast, Achilles tendon on the impaired side showed changes in the opposite direction as the muscle fascicles with increased tendon length (5%, P < 0.001), decreased tendon CSA (5%, P = 0.04), decreased tendon stiffness (42%, P < 0.001) and Young's modulus (30%, P < 0.001) compared with the unimpaired side. The fascicle and tendon stiffness changes were correlated negatively to the corresponding fascicle and tendon length changes, and decrease in Achilles tendon stiffness was correlated to the increases of SOL and GM fascicular stiffness (P < 0.05). Characterizations of calf muscle fascicles and Achilles tendon biomechanical properties help us better understand concurrent changes of fascicles and tendon as part of the calf muscle-tendon unit and facilitate development of more effective treatments.
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Affiliation(s)
- Heng Zhao
- Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and Mayo Clinic, Rochester, Minnesota
| | - Yupeng Ren
- Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and
| | - Elliot J Roth
- Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and
| | - Richard L Harvey
- Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and
| | - Li-Qun Zhang
- Rehabilitation Institute of Chicago, Illinois; Northwestern University, Chicago, Illinois; and
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Zhang LQ, Chen K, Kang SH, Sliwa JA, Cohen BA, Rymer WZ, Wang L. Characterizations of reflex and nonreflex changes in spastic multiple sclerosis. J Neurosci Methods 2014; 231:3-8. [PMID: 24472531 DOI: 10.1016/j.jneumeth.2014.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 12/10/2013] [Accepted: 01/16/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Spasticity, an increased resistance of a limb to movement, is associated with functional limitations and a major source of disability in neurological disorders, including multiple sclerosis (MS) and stroke. Despite the clinical significance of spasticity in brain and spinal cord injuries, it is often not clear whether the spasticity is due to reflex or non-reflex changes. NEW METHOD Reflex and nonreflex properties of the human knee joint were studied in eight MS patients with spasticity and ten healthy subjects. A digitally controlled joint driving device was used to apply small-amplitude, and band-limited white-noise perturbations to the knee to manifest the reflex and nonreflex properties. The subjects were asked to maintain a steady level of background muscle torque during the perturbation. A nonlinear delay differential equation model was used to characterize the reflex and intrinsic properties of the knee in terms of phasic stretch reflex gain, tonic stretch reflex gain, joint elastic stiffness, and coefficient of viscosity. RESULTS It was found that joint coefficient of viscosity and tonic stretch reflex gain of the spastic MS patients were significantly lower than those of normal controls. On the other hand, spastic MS patients showed higher phasic stretch reflex gains than normal controls and a trend of increased joint stiffness. CONCLUSIONS Simultaneous characterizations of changes in tonic and phasic reflexes and nonreflex changes in joint elastic stiffness and viscosity in neurological disorders may help us gain insight into mechanisms underlying spasticity and develop impairment-specific treatment.
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Affiliation(s)
- Li-Qun Zhang
- Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois 60611, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, 345 East Superior Street, Chicago, Illinois 60611, USA; Department of Orthopaedic Surgery, Northwestern University, 676 N. St. Clair Street, Chicago, Illinois 60611, USA; Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, Evanston, Illinois 60208, USA.
| | - Kai Chen
- Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois 60611, USA
| | - Sang Hoon Kang
- Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois 60611, USA
| | - James A Sliwa
- Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois 60611, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, 345 East Superior Street, Chicago, Illinois 60611, USA
| | - Bruce A Cohen
- Davee Department of Neurology and Clinical Neurosciences, Northwestern University, 710 North Lake Shore Drive, Chicago, IL 60611, USA
| | - W Z Rymer
- Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois 60611, USA; Department of Physical Medicine and Rehabilitation, Northwestern University, 345 East Superior Street, Chicago, Illinois 60611, USA; Department of Physiology, Northwestern University, 310 E. Superior Street, Chicago, Illinois 60611, USA
| | - Liang Wang
- Rehabilitation Institute of Chicago, 345 East Superior Street, Chicago, Illinois 60611, USA
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48
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Kang SH, Ren Y, Xu D, Zhang LQ. Lower-limb multi-joint stiffness of knee and ankle. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:4009-4012. [PMID: 25570871 DOI: 10.1109/embc.2014.6944503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lower-limb multi-joint (knee and ankle) stiffness may play an important role in functional activities such as walking, and may be significantly altered post stroke. Thus, determination of lower-limb multi joint stiffness matrix is important for better understanding of gait and of pathological changes post stroke. In this study, using novel dynamics decomposition, the knee and ankle joint stiffness matrix including cross-coupled stiffness terms between the two joints were determined and reported ever first. The determined stiffness matrix may be useful for gait studies, and can be served as a baseline for studying pathophysiological changes post stroke.
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49
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Lee H, Ho P, Rastgaar M, Krebs HI, Hogan N. Multivariable Static Ankle Mechanical Impedance With Active Muscles. IEEE Trans Neural Syst Rehabil Eng 2014; 22:44-52. [DOI: 10.1109/tnsre.2013.2262689] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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50
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Zhang LQ, Chung SG, Ren Y, Liu L, Roth EJ, Rymer WZ. Simultaneous characterizations of reflex and nonreflex dynamic and static changes in spastic hemiparesis. J Neurophysiol 2013; 110:418-30. [PMID: 23636726 PMCID: PMC3727067 DOI: 10.1152/jn.00573.2012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 04/30/2013] [Indexed: 11/22/2022] Open
Abstract
This study characterizes tonic and phasic stretch reflex and stiffness and viscosity changes associated with spastic hemiparesis. Perturbations were applied to the ankle of 27 hemiparetic and 36 healthy subjects under relaxed or active contracting conditions. A nonlinear delay differential equation model characterized phasic and tonic stretch reflex gains, elastic stiffness, and viscous damping. Tendon reflex was characterized with reflex gain and threshold. Reflexively, tonic reflex gain was increased in spastic ankles at rest (P < 0.038) and was not regulated with muscle contraction, indicating impaired tonic stretch reflex. Phasic-reflex gain in spastic plantar flexors was higher and increased faster with plantar flexor contraction (P < 0.012) than controls (P < 0.023) and higher in dorsi-flexors at lower torques (P < 0.038), primarily because of its increase at rest (P = 0.045), indicating exaggerated phasic stretch reflex especially in more spastic plantar flexors, which showed higher phasic stretch reflex gain than dorsi-flexors (P < 0.032). Spasticity was associated with increased tendon reflex gain (P = 0.002) and decreased threshold (P < 0.001). Mechanically, stiffness in spastic ankles was higher than that in controls across plantar flexion/dorsi-flexion torque levels (P < 0.032), and the more spastic plantar flexors were stiffer than dorsi-flexors at comparable torques (P < 0.031). Increased stiffness in spastic ankles was mainly due to passive stiffness increase (P < 0.001), indicating increased connective tissues/shortened fascicles. Viscous damping in spastic ankles was increased across the plantar flexion torque levels and at lower dorsi-flexion torques, reflecting increased passive viscous damping (P = 0.033). The more spastic plantar flexors showed higher viscous damping than dorsi-flexors at comparable torque levels (P < 0.047). Simultaneous characterizations of reflex and nonreflex changes in spastic hemiparesis may help to evaluate and treat them more effectively.
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Affiliation(s)
- Li-Qun Zhang
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
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