Aditi A Mullick - Academia.edu (original) (raw)
Papers by Aditi A Mullick
Physical Therapy, 2015
Background Commonly used spasticity scales assess the resistance felt by the evaluator during pas... more Background Commonly used spasticity scales assess the resistance felt by the evaluator during passive stretching. These scales, however, have questionable validity and reliability. The tonic stretch reflex threshold (TSRT), or the angle at which motoneuronal recruitment begins in the resting state, is a promising alternative for spasticity measurement. Previous studies showed that spasticity and voluntary motor deficits after stroke may be characterized by a limitation in the ability of the central nervous system to regulate the range of the TSRT. Objective The study objective was to assess interevaluator reliability for TSRT plantar-flexor spasticity measurement. Design This was an interevaluator reliability study. Methods In 28 people after stroke, plantar-flexor spasticity was evaluated twice on the same day. Plantar-flexor muscles were stretched 20 times at different velocities assigned by a portable device. Plantar-flexor electromyographic signals and ankle angles were used to ...
Reflex threshold measures discriminate between spasticity and rigidity
Stroke
Restorative Neurology and Neuroscience, 2015
Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Al... more Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Although evidence is emerging about specific relationships between cognitive deficits and upper-limb motor recovery, the practical implication of these relationships for rehabilitation is unclear. Using a structured review and meta-analyses, we examined the nature and strength of the associations between cognitive deficits and upper-limb motor recovery in studies of patients with stroke. Methods: Motor recovery was defined using measures of upper limb motor impairment and/or activity limitations. Studies were included if they reported on at least one measure of cognitive function and one measure of upper limb motor impairment or function. Results: Six studies met the selection criteria. There was a moderate association (r = 0.43; confidence interval; CI:0.09-0.68, p = 0.014) between cognition and overall arm motor recovery. Separate meta-analyses showed a moderately strong association between executive function and motor recovery (r = 0.48; CI:0.26-0.65; p < 0.001), a weak positive correlation between attention and motor recovery (r = 0.25; CI:0.04-0.45; p = 0.023), and no correlation between memory and motor recovery (r = 0.42; CI:0.16-0.79; p = 0.14). These results imply that information on the presence of cognitive deficits should be considered while planning interventions for clients in order to design more personalized interventions tailored to the individual for maximizing upper-limb recovery.
A New Standard in Objective Measurement of Spasticity
Journal of Medical Devices, 2013
Abnormalities of muscle tone are an integral component of many chronic motor disorders affecting ... more Abnormalities of muscle tone are an integral component of many chronic motor disorders affecting the central nervous system (CNS) in children and adults. Excessive, disabling muscle tone is called ‘spasticity’. Spasticity can interfere with movement and can lead to stiff, painful joints [1]. Over half a million people in the United States and 12 million worldwide are affected by spasticity. Spasticity results from dysgenesis or injury to sensorimotor pathways in the cortex, basal ganglia, thalamus, cerebellum, brainstem, central white matter, or spinal cord. Injury occurring in children is known as cerebral palsy (CP) [2]. In adults, CNS injury or disease associated with spasticity includes stroke, spinal cord injury, multiple sclerosis and traumatic brain injury. Although the presence or absence of spasticity can be identified using current clinical scales, the accuracy of determination of spasticity severity and the relationship between severity level and deficits of voluntary movements remain elusive (see [3,4]). These questions are of interest to both researchers and clinicians, because the precise quantification of spasticity is important to establish medical and physical therapeutic effectiveness. We designed a new measure of spasticity, called the Montreal Stretch Reflex Threshold (MSRT) measure, based on a) Lance’s definition [5] of spasticity as "a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex arc" and b) the threshold control theory of motor control [6]. This concept of measurement based on the velocitydependent stretch reflex threshold is a departure from the more common approach that characterizes the resistance to stretch of the passive muscle (e.g., [7]) and is likely to be more related to motor control deficits than resistance measures. If so, this may lead to a better ability to diagnose the motor impairment in spasticity and may lead to improved patient care. Thus, instead of determining the level of the resistance to stretch of the muscle as is usually done to assess spasticity, the main measure in the new device is the threshold joint angle at which the tonic stretch reflex (TSR) starts to produce resistance, which is clinically identified as spasticity.
Clinical Neurophysiology, 2013
h i g h l i g h t s Spasticity and rigidity can be differentiated based on the differences in the... more h i g h l i g h t s Spasticity and rigidity can be differentiated based on the differences in the central regulation of the spatial stretch reflex threshold. Both types of hypertonicity are characterized by a decrease in the range of central regulation of spatial thresholds but their sensitivity to velocity is greater in spasticity than in rigidity. Determination of spatial thresholds may be a more sensitive measure of changes in muscle tone than other measures. a b s t r a c t Objective: Muscle spasticity following stroke has been shown to result from limitations in the range of regulation of the tonic reflex spatial threshold (ST), i.e., the joint angle at which the stretch reflex begins to act due to descending and segmental influences on motoneurons. The purpose of this study was to determine whether spasticity due to stroke and rigidity due to parkinsonism can be discriminated based on the ST measure. Methods: Elbow muscles were stretched at different velocities in healthy, stroke (spasticity) and parkinsonism (rigidity) subjects. The elbow angle at which muscle activation began for each stretch velocity (dynamic ST) and the velocity sensitivity of the ST were measured. Dynamic ST values extrapolated to zero velocity defined the tonic ST. Results: Compared to healthy subjects, spasticity and rigidity were associated with a decrease in the range of central regulation of tonic STs. STs were hypersensitive in spastic muscles and either hypo-or inversely sensitive to stretch velocity in rigid muscles. Conclusions: ST characteristics discriminate between neurological deficits of muscle tone. Significance: Results suggest that spasticity and rigidity result from deficits in descending facilitatory control combined with deficits in dynamic fusimotor or/and presynaptic control of Ia inputs to motoneurons.
2013 International Conference on Virtual Rehabilitation (ICVR), 2013
The ability to avoid obstacles during reaching in a virtual environment (VE) was compared between... more The ability to avoid obstacles during reaching in a virtual environment (VE) was compared between post-stroke individuals with well-recovered upper limbs (UL) and healthy controls. Stroke subjects ranked well in UL clinical assessments. However, even though well-recovered, stroke subjects still had residual movement deficits and made more errors in the obstacle avoidance reaching task compared to controls. Reaching movement deficits were only revealed because of the challenging motor task. Therefore, the potential of using complex UL tasks to challenge the sensorimotor system and reveal deficits in higherorder sensorimotor function should be considered when assessing individuals after stroke.
Physiotherapy, 2015
joints were significantly different from each other, at a given force. Conclusion(s): This close ... more joints were significantly different from each other, at a given force. Conclusion(s): This close to final prototype of the PA pressure Puffin reliably measures segmental spinal stiffness and its ergonomically designed handle provides a promising tool for physical therapists applying PA pressure. The device further distinguishes between variously mobile spinal segments. Further research is needed for validation and reliability assessments under different conditions. Implications: Evidence based practice requires sound and objective assessment procedures which flawless treatment is determined by. It is therefore important to develop objective measurements at all levels of the assessment procedure. This close to final prototype of the PA pressure Puffin introduced has the potential to be used as a measurement tool in the clinic as well as for research. This device is further expected to serve as a training tool for physical therapy students who may improve their skills as future evidence based practitioners. The ergonomically designed handle is assumed to decrease the risk of repetitive strain injuries to those who might use the device.
Neurorehabilitation and Neural Repair
Background. Poststroke individuals use their paretic arms less often than expected in daily life ... more Background. Poststroke individuals use their paretic arms less often than expected in daily life situations, even when motor recovery is scored highly in clinical tests. Real-world environments are often unpredictable and require the ability to multitask and make decisions about rapid and accurate arm movement adjustments. Objective. To identify whether and to what extent cognitive–motor deficits in well-recovered individuals with stroke affect the ability to rapidly adapt reaching movements in changing cognitive and environmental conditions. Methods. Thirteen individuals with mild stroke and 11 healthy controls performed an obstacle avoidance task in a virtual environment while standing. Subjects reached for a virtual juice bottle with their hemiparetic arm as quickly as possible under single- and dual-task conditions. In the single-task condition, a sliding glass door partially obstructed the reaching path of the paretic arm. A successful trial was counted when the subject touched...
Neurorehabilitation and Neural Repair
Kinematic redundancy of the human body provides abundant movement patterns to accomplish the same... more Kinematic redundancy of the human body provides abundant movement patterns to accomplish the same motor goals (motor equivalence). Compensatory movement patterns such as excessive trunk displacement in stroke subjects during reaching can be viewed as a consequence of the motor equivalent process to accomplish a task despite limited available ranges in some joints. However, despite compensations, the ability to adapt reaching performance when perturbations occur may still be limited when condition-specific changes of joint angles are required. We addressed this hypothesis in individuals with and without stroke for reaching a target placed beyond arm reach in standing while flexing the hips (freehip condition). In randomly selected trials, hip flexion was unexpectedly blocked, forcing subjects to take a step (blockedhip condition). In additional trials, subjects took an intentional step while reaching the target (intentional-step condition). In blocked-hip trials, healthy subjects maintained smooth and precise endpoint trajectories by adapting temporal and spatial interjoint coordination to neutralize the effect of the perturbation. However, the ability to produce motor equivalent solutions was reduced in subjects with stroke, evidenced by substantial overshoot errors in endpoint position, reduced movement smoothness and less adaptive elbow-shoulder interjoint coordination. Movement adaptability was more limited in stroke subjects who used more compensatory movements for unperturbed reaching. Results suggest that subjects with mild-to-moderate stroke only partially adapted arm joint movements to maintain reaching performance. Therapeutic efforts to enhance the ability of individuals with stroke to find a larger number of task-relevant motor solutions (adaptability) may improve upper limb recovery.
Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity in adults with stroke: A systematic review and meta-analysis
Archives of physical medicine and rehabilitation, Jan 16, 2018
1. To determine the effect of transcutaneous electrical nerve stimulation (TENS) on post-stroke s... more 1. To determine the effect of transcutaneous electrical nerve stimulation (TENS) on post-stroke spasticity. 2a. To determine the effect of different parameters (intensity, frequency, and duration) of TENS on spasticity reduction in adults with stroke; 2b. To determine the influence of time since stroke on the effectiveness of TENS on spasticity. PubMed, PEDro, CINAHL, Web of Science, CENTRAL and EMBASE databases were searched from inception to March 2017. Randomized controlled trial (RCT), quasi RCT and non-RCT were included if: (a) they evaluated the effects of TENS for the management of spasticity in participants with acute/sub-acute/chronic stroke using clinical and neurophysiological tools; and (b) TENS was delivered either alone or as an adjunct to other treatments. Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro-forma. Disagreements were resolved through discussion with other authors. Qualit...
Facilitators and barriers to using neurological outcome measures in developed and developing countries
Physiotherapy Research International
Referent control of the orientation of posture and movement in the gravitational field
Experimental brain research, Feb 1, 2018
This study addresses the question of how posture and movement are oriented with respect to the di... more This study addresses the question of how posture and movement are oriented with respect to the direction of gravity. It is suggested that neural control levels coordinate spatial thresholds at which multiple muscles begin to be activated to specify a referent body orientation (RO) at which muscle activity is minimized. Under the influence of gravity, the body is deflected from the RO to an actual orientation (AO) until the emerging muscle activity and forces begin to balance gravitational forces and maintain body stability. We assumed that (1) during quiet standing on differently tilted surfaces, the same RO and thus AO can be maintained by adjusting activation thresholds of ankle muscles according to the surface tilt angle; (2) intentional forward body leaning results from monotonic ramp-and-hold shifts in the RO; (3) rhythmic oscillation of the RO about the ankle joints during standing results in body swaying. At certain sway phases, the AO and RO may transiently overlap, resultin...
Current Practices of Physical and Occupational Therapists Regarding Spasticity Assessment and Treatment
Physiotherapy Canada
Neurorehabilitation and Neural Repair
Background. Upper limb (UL) poststroke hemiparesis commonly leads to chronic disability. Despite ... more Background. Upper limb (UL) poststroke hemiparesis commonly leads to chronic disability. Despite moderate-to-good clinical recovery, many patients with UL hemiparesis still do not fully use their arm in daily tasks. Decreased arm use may be related to deficits in performance of more complex movement than what is usually assessed clinically. Objective. To identify differences between poststroke and nondisabled control subjects in making complex corrective movements to avoid an obstacle in the reaching path. Methods. Subjects rapidly reached for a juice bottle on a refrigerator shelf with their hemiparetic or dominant (controls) arm viewed in a large-screen projected 3D virtual environment. In random trials, a sliding door partially obstructed the reaching path. A successful trial was one in which subjects touched the bottle without their arm or hand hitting the door. Results. Fewer participants with stroke (12%) were successful at a 65% success rate in avoiding the door compared to c...
Physical Therapy, 2015
Background Commonly used spasticity scales assess the resistance felt by the evaluator during pas... more Background Commonly used spasticity scales assess the resistance felt by the evaluator during passive stretching. These scales, however, have questionable validity and reliability. The tonic stretch reflex threshold (TSRT), or the angle at which motoneuronal recruitment begins in the resting state, is a promising alternative for spasticity measurement. Previous studies showed that spasticity and voluntary motor deficits after stroke may be characterized by a limitation in the ability of the central nervous system to regulate the range of the TSRT. Objective The study objective was to assess interevaluator reliability for TSRT plantar-flexor spasticity measurement. Design This was an interevaluator reliability study. Methods In 28 people after stroke, plantar-flexor spasticity was evaluated twice on the same day. Plantar-flexor muscles were stretched 20 times at different velocities assigned by a portable device. Plantar-flexor electromyographic signals and ankle angles were used to ...
Reflex threshold measures discriminate between spasticity and rigidity
Stroke
Restorative Neurology and Neuroscience, 2015
Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Al... more Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Although evidence is emerging about specific relationships between cognitive deficits and upper-limb motor recovery, the practical implication of these relationships for rehabilitation is unclear. Using a structured review and meta-analyses, we examined the nature and strength of the associations between cognitive deficits and upper-limb motor recovery in studies of patients with stroke. Methods: Motor recovery was defined using measures of upper limb motor impairment and/or activity limitations. Studies were included if they reported on at least one measure of cognitive function and one measure of upper limb motor impairment or function. Results: Six studies met the selection criteria. There was a moderate association (r = 0.43; confidence interval; CI:0.09-0.68, p = 0.014) between cognition and overall arm motor recovery. Separate meta-analyses showed a moderately strong association between executive function and motor recovery (r = 0.48; CI:0.26-0.65; p < 0.001), a weak positive correlation between attention and motor recovery (r = 0.25; CI:0.04-0.45; p = 0.023), and no correlation between memory and motor recovery (r = 0.42; CI:0.16-0.79; p = 0.14). These results imply that information on the presence of cognitive deficits should be considered while planning interventions for clients in order to design more personalized interventions tailored to the individual for maximizing upper-limb recovery.
A New Standard in Objective Measurement of Spasticity
Journal of Medical Devices, 2013
Abnormalities of muscle tone are an integral component of many chronic motor disorders affecting ... more Abnormalities of muscle tone are an integral component of many chronic motor disorders affecting the central nervous system (CNS) in children and adults. Excessive, disabling muscle tone is called ‘spasticity’. Spasticity can interfere with movement and can lead to stiff, painful joints [1]. Over half a million people in the United States and 12 million worldwide are affected by spasticity. Spasticity results from dysgenesis or injury to sensorimotor pathways in the cortex, basal ganglia, thalamus, cerebellum, brainstem, central white matter, or spinal cord. Injury occurring in children is known as cerebral palsy (CP) [2]. In adults, CNS injury or disease associated with spasticity includes stroke, spinal cord injury, multiple sclerosis and traumatic brain injury. Although the presence or absence of spasticity can be identified using current clinical scales, the accuracy of determination of spasticity severity and the relationship between severity level and deficits of voluntary movements remain elusive (see [3,4]). These questions are of interest to both researchers and clinicians, because the precise quantification of spasticity is important to establish medical and physical therapeutic effectiveness. We designed a new measure of spasticity, called the Montreal Stretch Reflex Threshold (MSRT) measure, based on a) Lance’s definition [5] of spasticity as "a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex arc" and b) the threshold control theory of motor control [6]. This concept of measurement based on the velocitydependent stretch reflex threshold is a departure from the more common approach that characterizes the resistance to stretch of the passive muscle (e.g., [7]) and is likely to be more related to motor control deficits than resistance measures. If so, this may lead to a better ability to diagnose the motor impairment in spasticity and may lead to improved patient care. Thus, instead of determining the level of the resistance to stretch of the muscle as is usually done to assess spasticity, the main measure in the new device is the threshold joint angle at which the tonic stretch reflex (TSR) starts to produce resistance, which is clinically identified as spasticity.
Clinical Neurophysiology, 2013
h i g h l i g h t s Spasticity and rigidity can be differentiated based on the differences in the... more h i g h l i g h t s Spasticity and rigidity can be differentiated based on the differences in the central regulation of the spatial stretch reflex threshold. Both types of hypertonicity are characterized by a decrease in the range of central regulation of spatial thresholds but their sensitivity to velocity is greater in spasticity than in rigidity. Determination of spatial thresholds may be a more sensitive measure of changes in muscle tone than other measures. a b s t r a c t Objective: Muscle spasticity following stroke has been shown to result from limitations in the range of regulation of the tonic reflex spatial threshold (ST), i.e., the joint angle at which the stretch reflex begins to act due to descending and segmental influences on motoneurons. The purpose of this study was to determine whether spasticity due to stroke and rigidity due to parkinsonism can be discriminated based on the ST measure. Methods: Elbow muscles were stretched at different velocities in healthy, stroke (spasticity) and parkinsonism (rigidity) subjects. The elbow angle at which muscle activation began for each stretch velocity (dynamic ST) and the velocity sensitivity of the ST were measured. Dynamic ST values extrapolated to zero velocity defined the tonic ST. Results: Compared to healthy subjects, spasticity and rigidity were associated with a decrease in the range of central regulation of tonic STs. STs were hypersensitive in spastic muscles and either hypo-or inversely sensitive to stretch velocity in rigid muscles. Conclusions: ST characteristics discriminate between neurological deficits of muscle tone. Significance: Results suggest that spasticity and rigidity result from deficits in descending facilitatory control combined with deficits in dynamic fusimotor or/and presynaptic control of Ia inputs to motoneurons.
2013 International Conference on Virtual Rehabilitation (ICVR), 2013
The ability to avoid obstacles during reaching in a virtual environment (VE) was compared between... more The ability to avoid obstacles during reaching in a virtual environment (VE) was compared between post-stroke individuals with well-recovered upper limbs (UL) and healthy controls. Stroke subjects ranked well in UL clinical assessments. However, even though well-recovered, stroke subjects still had residual movement deficits and made more errors in the obstacle avoidance reaching task compared to controls. Reaching movement deficits were only revealed because of the challenging motor task. Therefore, the potential of using complex UL tasks to challenge the sensorimotor system and reveal deficits in higherorder sensorimotor function should be considered when assessing individuals after stroke.
Physiotherapy, 2015
joints were significantly different from each other, at a given force. Conclusion(s): This close ... more joints were significantly different from each other, at a given force. Conclusion(s): This close to final prototype of the PA pressure Puffin reliably measures segmental spinal stiffness and its ergonomically designed handle provides a promising tool for physical therapists applying PA pressure. The device further distinguishes between variously mobile spinal segments. Further research is needed for validation and reliability assessments under different conditions. Implications: Evidence based practice requires sound and objective assessment procedures which flawless treatment is determined by. It is therefore important to develop objective measurements at all levels of the assessment procedure. This close to final prototype of the PA pressure Puffin introduced has the potential to be used as a measurement tool in the clinic as well as for research. This device is further expected to serve as a training tool for physical therapy students who may improve their skills as future evidence based practitioners. The ergonomically designed handle is assumed to decrease the risk of repetitive strain injuries to those who might use the device.
Neurorehabilitation and Neural Repair
Background. Poststroke individuals use their paretic arms less often than expected in daily life ... more Background. Poststroke individuals use their paretic arms less often than expected in daily life situations, even when motor recovery is scored highly in clinical tests. Real-world environments are often unpredictable and require the ability to multitask and make decisions about rapid and accurate arm movement adjustments. Objective. To identify whether and to what extent cognitive–motor deficits in well-recovered individuals with stroke affect the ability to rapidly adapt reaching movements in changing cognitive and environmental conditions. Methods. Thirteen individuals with mild stroke and 11 healthy controls performed an obstacle avoidance task in a virtual environment while standing. Subjects reached for a virtual juice bottle with their hemiparetic arm as quickly as possible under single- and dual-task conditions. In the single-task condition, a sliding glass door partially obstructed the reaching path of the paretic arm. A successful trial was counted when the subject touched...
Neurorehabilitation and Neural Repair
Kinematic redundancy of the human body provides abundant movement patterns to accomplish the same... more Kinematic redundancy of the human body provides abundant movement patterns to accomplish the same motor goals (motor equivalence). Compensatory movement patterns such as excessive trunk displacement in stroke subjects during reaching can be viewed as a consequence of the motor equivalent process to accomplish a task despite limited available ranges in some joints. However, despite compensations, the ability to adapt reaching performance when perturbations occur may still be limited when condition-specific changes of joint angles are required. We addressed this hypothesis in individuals with and without stroke for reaching a target placed beyond arm reach in standing while flexing the hips (freehip condition). In randomly selected trials, hip flexion was unexpectedly blocked, forcing subjects to take a step (blockedhip condition). In additional trials, subjects took an intentional step while reaching the target (intentional-step condition). In blocked-hip trials, healthy subjects maintained smooth and precise endpoint trajectories by adapting temporal and spatial interjoint coordination to neutralize the effect of the perturbation. However, the ability to produce motor equivalent solutions was reduced in subjects with stroke, evidenced by substantial overshoot errors in endpoint position, reduced movement smoothness and less adaptive elbow-shoulder interjoint coordination. Movement adaptability was more limited in stroke subjects who used more compensatory movements for unperturbed reaching. Results suggest that subjects with mild-to-moderate stroke only partially adapted arm joint movements to maintain reaching performance. Therapeutic efforts to enhance the ability of individuals with stroke to find a larger number of task-relevant motor solutions (adaptability) may improve upper limb recovery.
Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity in adults with stroke: A systematic review and meta-analysis
Archives of physical medicine and rehabilitation, Jan 16, 2018
1. To determine the effect of transcutaneous electrical nerve stimulation (TENS) on post-stroke s... more 1. To determine the effect of transcutaneous electrical nerve stimulation (TENS) on post-stroke spasticity. 2a. To determine the effect of different parameters (intensity, frequency, and duration) of TENS on spasticity reduction in adults with stroke; 2b. To determine the influence of time since stroke on the effectiveness of TENS on spasticity. PubMed, PEDro, CINAHL, Web of Science, CENTRAL and EMBASE databases were searched from inception to March 2017. Randomized controlled trial (RCT), quasi RCT and non-RCT were included if: (a) they evaluated the effects of TENS for the management of spasticity in participants with acute/sub-acute/chronic stroke using clinical and neurophysiological tools; and (b) TENS was delivered either alone or as an adjunct to other treatments. Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro-forma. Disagreements were resolved through discussion with other authors. Qualit...
Facilitators and barriers to using neurological outcome measures in developed and developing countries
Physiotherapy Research International
Referent control of the orientation of posture and movement in the gravitational field
Experimental brain research, Feb 1, 2018
This study addresses the question of how posture and movement are oriented with respect to the di... more This study addresses the question of how posture and movement are oriented with respect to the direction of gravity. It is suggested that neural control levels coordinate spatial thresholds at which multiple muscles begin to be activated to specify a referent body orientation (RO) at which muscle activity is minimized. Under the influence of gravity, the body is deflected from the RO to an actual orientation (AO) until the emerging muscle activity and forces begin to balance gravitational forces and maintain body stability. We assumed that (1) during quiet standing on differently tilted surfaces, the same RO and thus AO can be maintained by adjusting activation thresholds of ankle muscles according to the surface tilt angle; (2) intentional forward body leaning results from monotonic ramp-and-hold shifts in the RO; (3) rhythmic oscillation of the RO about the ankle joints during standing results in body swaying. At certain sway phases, the AO and RO may transiently overlap, resultin...
Current Practices of Physical and Occupational Therapists Regarding Spasticity Assessment and Treatment
Physiotherapy Canada
Neurorehabilitation and Neural Repair
Background. Upper limb (UL) poststroke hemiparesis commonly leads to chronic disability. Despite ... more Background. Upper limb (UL) poststroke hemiparesis commonly leads to chronic disability. Despite moderate-to-good clinical recovery, many patients with UL hemiparesis still do not fully use their arm in daily tasks. Decreased arm use may be related to deficits in performance of more complex movement than what is usually assessed clinically. Objective. To identify differences between poststroke and nondisabled control subjects in making complex corrective movements to avoid an obstacle in the reaching path. Methods. Subjects rapidly reached for a juice bottle on a refrigerator shelf with their hemiparetic or dominant (controls) arm viewed in a large-screen projected 3D virtual environment. In random trials, a sliding door partially obstructed the reaching path. A successful trial was one in which subjects touched the bottle without their arm or hand hitting the door. Results. Fewer participants with stroke (12%) were successful at a 65% success rate in avoiding the door compared to c...