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Kanbayashi T, Ogawa G, Uesugi H, Kobayashi S, Stålberg E, Sonoo M. Utility of the Clustering Index method for diagnosing neuromuscular disorders as compared with needle electromyography. Muscle Nerve 2024. [PMID: 39132809 DOI: 10.1002/mus.28226] [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: 08/20/2023] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION/AIMS Concentric needle electromyography (CNEMG) is an essential examination for evaluating neuromuscular disorders, although pain is a drawback. Clustering Index (CI) method is a non-invasive quantitative analysis for surface electromyography (SEMG) that evaluates whether the signal area is clustered into the few large motor unit potentials (MUPs) or is evenly distributed. However, the diagnostic yield of the CI method in comparison with CNEMG is not known. In this study, we aimed to compare the sensitivity of the CI method with MUP parameters in CNEMG for diagnosing neurogenic or myogenic disorders. METHODS We retrospectively identified patients for whom both SEMG and CNEMG were performed on the same tibialis anterior (TA) muscle. In CNEMG, seven MUP parameters were evaluated, including size index (SI) and revised size indices for neurogenic (rSIn) and myogenic (rSIm) disorders. RESULTS Identified were 21 patients with neurogenic and 21 patients with myogenic disorders. Control data were constructed from 30 control subjects. The sensitivities of the CI method for the neurogenic and myogenic groups were 76% and 62%, respectively, which were not significantly different from MUP parameters, except for being significantly higher than those of amplitude and duration for myopathy (24%). Among MUP parameters, the sensitivities of rSIn (62%) and rSIm (57%) for myopathy were significantly higher than those of amplitude and duration. The CI method significantly correlated with the strength of the TA muscle in myopathy. DISCUSSION The CI method, having comparable diagnostic yields to MUP parameters, is promising as a non-invasive diagnostic measure.
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Affiliation(s)
| | - Go Ogawa
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Haruo Uesugi
- Department of Neurology, Aizen Hospital, Sapporo, Hokkaido, Japan
| | - Shunsuke Kobayashi
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
| | - Erik Stålberg
- Department of Clinical Neurophysiology, Uppsala University, Uppsala, Sweden
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan
- Department of Orthoptics, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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Hur Y, Oh BM, Seo HG, Hyun SE, Kim DJ, Kim H, Han TS, Park HJ, Lee CH, Lee WH. Reliability of Surface Electromyography From the Lower-limb Muscles During Maximal and Submaximal Voluntary Isometric Contractions in In-bed Healthy Individuals and Patients With Subacute Stroke. BRAIN & NEUROREHABILITATION 2024; 17:e14. [PMID: 39113922 PMCID: PMC11300959 DOI: 10.12786/bn.2024.17.e14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
This study aims to develop maximal voluntary isometric contraction (MVIC) and submaximal voluntary isometric contraction (subMVIC) methods and to assess the reliability of the developed methods for in-bed healthy individuals and patients with subacute stroke. The electromyography (EMG) activities from the lower-limb muscles including the tensor fascia lata (TFL), rectus femoris (RF), tibialis anterior (TA), and gastrocnemius (GC) on both sides were recorded during MVIC and subMVIC using surface EMG sensors in 20 healthy individuals and 20 subacute stroke patients. In inter-trial reliability, both MVIC and subMVIC methods demonstrated excellent reliability for all the measured muscles at baseline and follow-up evaluations in both healthy individuals and stroke patients. In inter-day reliability, MVIC showed good reliability for the TFL and moderate reliability for the RF, TA, and GC, while subMVIC showed good reliability for the TFL, RF, and GC and poor reliability for the TA in healthy individuals. In conclusion, the MVIC and subMVIC methods of EMG activities were feasible in in-bed healthy individuals and patients with subacute stroke. The results can serve as a basis for the clinical evaluation of muscular activities using quantitative EMG signals on the lower-limb muscles in stroke patients with impaired mobility.
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Affiliation(s)
- Yong Hur
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
- Department of Artificial Intelligence, Korea University, Seoul, Korea
- NeuroTx Co., Ltd., Seoul, Korea
| | - Hakseung Kim
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Tae-Seong Han
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Hye Jung Park
- Department of Rehabilitation Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chae Hyeon Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Bao SC, Sun R, Tong RKY. Pedaling Asymmetry Reflected by Bilateral EMG Complexity in Chronic Stroke. ENTROPY (BASEL, SWITZERLAND) 2024; 26:538. [PMID: 39056901 PMCID: PMC11275654 DOI: 10.3390/e26070538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/16/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
This study examines pedaling asymmetry using the electromyogram (EMG) complexity of six bilateral lower limb muscles for chronic stroke survivors. Fifteen unilateral chronic stroke and twelve healthy participants joined passive and volitional recumbent pedaling tasks using a self-modified stationary bike with a constant speed of 25 revolutions per minute. The fuzzy approximate entropy (fApEn) was adopted in EMG complexity estimation. EMG complexity values of stroke participants during pedaling were smaller than those of healthy participants (p = 0.002). For chronic stroke participants, the complexity of paretic limbs was smaller than that of non-paretic limbs during the passive pedaling task (p = 0.005). Additionally, there was a significant correlation between clinical scores and the paretic EMG complexity during passive pedaling (p = 0.022, p = 0.028), indicating that the paretic EMG complexity during passive movement might serve as an indicator of stroke motor function status. This study suggests that EMG complexity is an appropriate quantitative tool for measuring neuromuscular characteristics in lower limb dynamic movement tasks for chronic stroke survivors.
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Affiliation(s)
- Shi-Chun Bao
- National Innovation Center for Advanced Medical Devices, Shenzhen 518110, China
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Rui Sun
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
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Kollai S, Bereczki D, Glasz T, Hortobágyi T, Kovács T. Early histopathological changes of secondary degeneration in the spinal cord after total MCA territory stroke. Sci Rep 2023; 13:21934. [PMID: 38082027 PMCID: PMC10713562 DOI: 10.1038/s41598-023-49230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
Previous research has not demonstrated secondary degeneration of the spinal cord (SpC) motoneurons after cerebral infarct. The aim of the present study is to investigate the involvement of the anterior horn cells (AHC) in the early post-stroke period using histomorphological and immunohistochemical methods. Post-mortem analysis of the 6th cervical segment was performed in 7 patients who had total MCA stroke within 1 month before death. Nissl-stained sections were used for morphometry, while CD68 and synaptophysin (SYP) immunohistochemistry to monitor microglial activation and synaptic changes in the anterior horn (AH), respectively. Contralateral to the cerebral lesion (contralesional side), cells were smaller after 3 days and larger after 1 week of stroke, especially regarding the large alpha motoneurons. CD68 density increased mainly on the contralesional Rexed's IX lamina of the SpC. SYP coverage of the large motoneurons was reduced on the contralesional side. Early microglial activation in the AH and electrophysiological signs has suggested the possibility of impairment of anterior horn cells (AHC-s). Our study supported that early microglial activation in the contralesional side of the SpC may primarily affect the area corresponding to the location of large motoneurons, and is accompanied by a transient shrinkage followed by increase in size of the large AHC-s with a reduction of their synaptic coverage. After MCA stroke, early involvement of the SpC motoneurons may be suspected by their morphological and synaptic changes and by the pattern of microglial activation.
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Affiliation(s)
- Sarolta Kollai
- Department of Neurology, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
- Károly Schaffer Laboratory of Neuropathology, Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary
- HUN-REN-SU Neuroepidemiological Research Group, Budapest, Hungary
| | - Tibor Glasz
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Tibor Hortobágyi
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Old Age Psychiatry, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Tibor Kovács
- Department of Neurology, Semmelweis University, Balassa U. 6, Budapest, 1083, Hungary.
- Károly Schaffer Laboratory of Neuropathology, Department of Neurology, Semmelweis University, Budapest, Hungary.
- HUN-REN-SU Neuroepidemiological Research Group, Budapest, Hungary.
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Decoding finger movement patterns from microscopic neural drive information based on deep learning. Med Eng Phys 2022; 104:103797. [DOI: 10.1016/j.medengphy.2022.103797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/18/2022]
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Úbeda A, Costa-Garcia A, Torricelli D, Vujaklija I, Del Vecchio A. Editorial: Neuromechanical Biomarkers in Robot-Assisted Motor Rehabilitation. Front Neurorobot 2022; 15:831113. [PMID: 35095461 PMCID: PMC8789743 DOI: 10.3389/fnbot.2021.831113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrés Úbeda
- Human Robotics Group, Department of Physics, Systems Engineering and Signal Theory, University of Alicante, Alicante, Spain
- *Correspondence: Andrés Úbeda
| | - Alvaro Costa-Garcia
- Intelligent Behaviour Control Unit, CBS-Toyota Collaboration Center, RIKEN, Nagoya, Japan
| | - Diego Torricelli
- Instituto Cajal, Spanish National Research Council (CSIC), Madrid, Spain
| | - Ivan Vujaklija
- Bionic and Rehabilitation Engineering Group, Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Alessandro Del Vecchio
- Neuromuscular Physiology and Neural Interfacing Group, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander Universität, Erlangen-Nürnberg, Erlangen, Germany
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Richards J, Gechev A, Alexander J, Macedo L, May KA, Lindley SB. The Effect of Local Cooling at the Elbow on Nerve Conduction Velocity and Motor Unit Behaviour: An Exploration of a Novel Neurological Assessment. SENSORS 2021; 21:s21206703. [PMID: 34695914 PMCID: PMC8537108 DOI: 10.3390/s21206703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/02/2022]
Abstract
Background: This study aimed to determine the effects of a standard therapeutic cooling protocol using crushed ice on the elbow to explore if changes in the motor unit (MU) firing rates in the first dorsal interosseous (FDI) muscle are comparable to known changes in sensory and motor nerve conduction velocity (NCV) due to a regional temperature drop around a peripheral nerve. Methods: Twelve healthy individuals were assessed before cooling, immediately after cooling, and 15 min of rewarming. Assessments included two standard non-invasive nerve conduction velocity tests and a non-invasive investigation of the MU firing rates using surface electromyography decomposition (dEMG). Results: Repeated ANOVAs showed significant differences in the MU firing rates and NCV between time points (p = 0.01 and p < 0.001). All measures showed significant differences between pre and post cooling and between pre-cooling and 15 min of passive re-warming, however, no changes were seen between post cooling and rewarming except in the sensory NCV, which increased but did not return to the pre-cooled state. Conclusions: This current study showed a significant, temporary, and reversible reduction in ulnar NCV across the elbow in healthy subjects, which was associated with a significant decrease in mean MU firing rates in the FDI muscle.
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Affiliation(s)
- Jim Richards
- Allied Health Research Unit, University of Central Lancashire, Preston PR1 2HE, UK;
- Correspondence:
| | - Antonin Gechev
- Department of Clinical Neurophysiology, Royal Free London Hospital, London NW3 2QG, UK;
| | - Jill Alexander
- Allied Health Research Unit, University of Central Lancashire, Preston PR1 2HE, UK;
| | - Liane Macedo
- Faculty of Health Sciences of Trairí, Federal University of Rio Grande do Norte, Santa Cruz 59200-000, Brazil;
| | - Karen A. May
- School of Medicine, University of Central Lancashire, Preston PR1 2HE, UK;
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Balch MHH, Harris H, Chugh D, Gnyawali S, Rink C, Nimjee SM, Arnold WD. Ischemic stroke-induced polyaxonal innervation at the neuromuscular junction is attenuated by robot-assisted mechanical therapy. Exp Neurol 2021; 343:113767. [PMID: 34044000 DOI: 10.1016/j.expneurol.2021.113767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/30/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
Ischemic stroke is a leading cause of disability world-wide. Mounting evidence supports neuromuscular pathology following stroke, yet mechanisms of dysfunction and therapeutic action remain undefined. The objectives of our study were to investigate neuromuscular pathophysiology following ischemic stroke and to evaluate the therapeutic effect of Robot-Assisted Mechanical massage Therapy (RAMT) on neuromuscular junction (NMJ) morphology. Using an ischemic stroke model in male rats, we demonstrated longitudinal losses of muscle contractility and electrophysiological estimates of motor unit number in paretic hindlimb muscles within 21 days of stroke. Histological characterization demonstrated striking pre- and postsynaptic alterations at the NMJ. Stroke prompted enlargement of motor axon terminals, acetylcholine receptor (AChR) area, and motor endplate size. Paretic muscle AChRs were also more homogenously distributed across motor endplates, exhibiting fewer clusters and less fragmentation. Most interestingly, NMJs in paretic muscle exhibited increased frequency of polyaxonal innervation. This finding of increased polyaxonal innervation in stroke-affected skeletal muscle suggests that reduction of motor unit number following stroke may be a spurious artifact due to overlapping of motor units rather than losses. Furthermore, we tested the effects of RAMT - which we recently showed to improve motor function and protect against subacute myokine disturbance - and found significant attenuation of stroke-induced NMJ alterations. RAMT not only normalized the post-stroke presentation of polyaxonal innervation but also mitigated postsynaptic expansion. These findings confirm complex neuromuscular pathophysiology after stroke, provide mechanistic direction for ongoing research, and inform development of future therapeutic strategies. SIGNIFICANCE: Ischemic stroke is a leading contributor to chronic disability, and there is growing evidence that neuromuscular pathology may contribute to the impact of stroke on physical function. Following ischemic stroke in a rat model, there are progressive declines of motor unit number estimates and muscle contractility. These changes are paralleled by striking pre- and postsynaptic maladaptive changes at the neuromuscular junction, including polyaxonal innervation. When administered to paretic hindlimb muscle, Robot-Assisted Mechanical massage Therapy - previously shown to improve motor function and protect against subacute myokine disturbance - prevents stroke-induced neuromuscular junction alterations. These novel observations provide insight into the neuromuscular response to cerebral ischemia, identify peripheral mechanisms of functional disability, and present a therapeutic rehabilitation strategy with clinical relevance.
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Affiliation(s)
- Maria H H Balch
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hallie Harris
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Deepti Chugh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Surya Gnyawali
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cameron Rink
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shahid M Nimjee
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - W David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Zhang X, Zhu G, Chen M, Chen X, Chen X, Zhou P. Muscle Force Estimation Based on Neural Drive Information From Individual Motor Units. IEEE Trans Neural Syst Rehabil Eng 2020; 28:3148-3157. [PMID: 33284755 DOI: 10.1109/tnsre.2020.3042788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Estimation of muscle contraction force based on the macroscopic feature of surface electromyography (SEMG) has been widely reported, but the use of microscopic neural drive information has not been thoroughly investigated. In this study, a novel method is proposed to process individual motor unit (MU) activities (firing sequences and action potential waveforms) derived from the decomposition of high density SEMG (HD-SEMG), and it is applied to muscle force estimation. In the proposed method, a supervised machine learning approach was conducted to determine the twitch force of each MU according to its action potential waveforms, which enables separate calculation of every MU's contribution to force. Thus, the muscle force was predicted through a physiologically meaningful muscle force model. In the experiment, HD-SEMG data were recorded from the abductor pollicis brevis muscles of eight healthy subjects during their performance of thumb abduction with the force increasing gradually from zero to four force levels (10%, 20%, 30%, 40% of the maximal voluntary contraction), while the true muscle force was measured simultaneously. When the proposed method was used, the root mean square difference (RMSD) of the error of the estimated force with respect to the measured force was reported to be 8.3% ± 2.8%. The proposed method also significantly outperformed the other four common methods for force estimation (RMSD: from 11.7% to 20%, ), demonstrating its effectiveness. This study offers a useful tool for exploiting the neural drive information towards muscle force estimation with improved precision. The proposed method has wide applications in precise motor control, sport and rehabilitation medicine.
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Lower limb muscle activities and gain in balancing ability following two types of stair gait intervention in adult post-chronic stroke patients: A preliminary, randomized-controlled study. Turk J Phys Med Rehabil 2020; 66:17-23. [PMID: 32318670 DOI: 10.5606/tftrd.2020.3335] [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: 07/04/2018] [Accepted: 10/23/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare the changes in lower limb muscle activities after stair ascending and descending training at two different heights of stairs in patients with chronic stroke and to suggest a stair height which is more effective in improving the strength and balancing ability of these patients. Patients and methods Between November 2016 and February 2017, a total of 20 patients (14 males, 6 females; mean age 56 years; range, 52 to 61 years) with hemiparesis were included in this randomized-controlled study. The patients were randomly assigned to the 10- or 15-cm stair height group (10- and 15-cm groups, respectively; n=10 in each). Both groups received comprehensive rehabilitation therapy and additionally performed stair gait training for 30 min four times per week for a total of six weeks. Balancing abilities and the activities of the paralyzed lower limb's rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius during stair ascending were measured before and after the stair gait training. Results During stair ascent, the 15-cm group showed significantly greater muscle activities of the rectus femoris, biceps femoris, and tibialis anterior than the 10-cm group (p<0.001, η2=0.115; p=0.001, η2=0.022; and p=0.001, η2=0.036, respectively). Conclusion Our study results suggest that ascending stairs with 15-cm step height results in a greater muscle activity than with a 10-cm step height.
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