Hemiplegia Research Papers - Academia.edu (original) (raw)

AIM Clinical determination of spasticity is confounded by the difficulty in distinguishing reflex from passive contributions to muscle stiffness. There is, therefore, a risk that children with cerebral palsy (CP) receive antispasticity treatment unnecessarily. To investigate this, we aimed to determine the contribution of reflex mechanisms to changes in the passive elastic properties of muscles and tendons in children with CP.

- by
- •
- Skeletal muscle biology, Cerebral Palsy, Adolescent, Child

I measured the knee extension torque, produced by eight hemiparetic patients during repeated knee extension-flexion reversals and during separated knee extension-flexion dyads, to determine the effect of "reversal of antagonists" on knee extension torque. The hemiparesis in these eight patients was secondary to intracranial lesions. I tested their involved lower extremity on an isokinetic dynamometer at 60°/sec. Using a sequential medical-trials design, I found knee extension torque to be significantly greater during repeated knee extensionflexion reversals than during separated knee extension-flexion dyads (p < .05). I, therefore, concluded that reversal of antagonists may facilitate knee extension torque production in the type of patients tested, under the specific conditions of their testing.

- by Richard Bohannon
- •
- Physical Therapy, Knee, Movement, Hemiplegia

Morris DM, Uswatte G, Crago JE, Cook EW III, Taub E. The reliability of the Wolf Motor Function Test for assessing upper extremity function after stroke. Arch Phys Med Rehabil 2001;82:750-5. Objective: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. Design: Interrater and test-retest reliability. Setting: A clinical research laboratory at a university medical center. Patients: A sample of convenience of 24 subjects with chronic hemiplegia (onset Ͼ1yr), showing moderate motor impairment.

- by Gitendra Uswatte
- •
- Adolescent, Stroke, Clinical research, Chronic Disease

The case of a man with a right hemisphere lesion and with evidence of left-sided visuospatial neglect is reported. On a variety of verbal and nonverbal tasks his performance was significantly modified by information implicit in stimulus configurations. Neglect deficits were present on tests involving spatially distinct or meaningless stimulus arrays but almost absent when stimuli were continuous or meaningfully integrated.

- by Luke Kartsounis
- •
- Psychometrics, Attention, Right Hemisphere Functions, Form perception

Alternating hemiplegia of children is a rare neurological disorder that in its characteristic form has few differential diagnosis. The diagnosis of intractable seizures is difficult to avoid for physicians not aware of the disease. To describe the clinical characteristics of Alternating Hemiplegia of Childhood (AHC), and response to various drugs A Ghanaian child with AHC was followed up for three years at the Neurology Clinic, Korle Bu Teaching Hospital, Accra. Her characteristics including EEG and MRI findings were documented. She was severely unsuccessfully treated as an epileptic. Further clinical re-evaluation provided clues to the diagnosis of alternating hemiplegia of childhood. The child, a female patient, was seen within the first week of life. The initial complaints were abnormal eye movements, and subsequently recurrent hemiplegic episodes, that started at age two and lasted hours to days. Attacks occurred at a frequency of about three per month and lasted from several ho...

- by E. Badoe
- •
- Magnetic Resonance Imaging, Epilepsy, Electroencephalography, Treatment Outcome
- by Roslyn Boyd
- •
- Psychology, Neurology, Autism, Magnetic Resonance Imaging

Functional electrical stimulation (FES) is an accepted treatment method for paresis or paralysis after spinal cord and head injury as well as stroke and other neurological upper motor neuron disorders. At the beginning, FES worked like an electrophysiological brace for the correction of drop foot of patients after a stroke. When analyzing early accomplishments, it becomes evident that FES was influenced rather by technological and biomedical engineering development than by contemporary knowledge on neurocontrol of movement in individuals with upper motor neuron paralysis. Nevertheless, with better understanding of pathophysiology of spasticity and neurocontrol of impaired movement, FES advanced from an electrophysiological brace to a treatment modality for the improvement of muscle control, neuroaugmentation of residual movements, and supportive procedure for "spontaneous recovery" of motor control. In the present article we shall illustrate barriers which delayed FES to be applied in clinical practice of neuron rehabilitation from "Yesterday" to "Today." We shall discuss the importance to apply FES early after the onset of neurological conditions to prevent disuse of noninjured portions of the CNS. Moreover, FES can play a significant role in the supporting processes of neuroplasticity in the subacute phase of upper motor neuron dysfunction. Therefore, the electrophysiological brace of "Yesterday" provides "Today" a correction of missing neuromuscular function. At the same time, it is an active external device for the correction of motor deficits interacting with the somatosensory-motor integration. Thus, "Yesterday" and "Today" of the same technological approach can be very different, thanks to a different understanding and assessment of "external" and "internal" components of human motor control.

A kinematic analysis was performed on goal-directed movements made by 14 patients with right hemisphere damage and left unilateral neglect (seven mild, seven severe), and 14 healthy controls. Leftward and rightward pen strokes of varying extents were made to targets of varying size on a centrally located digitising tablet. While mild unilateral neglect patients performed like controls, patients with severe unilateral neglect were slower to initiate leftward than rightward strokes and were slow and inefficient in movement execution. Leftward strokes made by severe unilateral neglect patients were characterised by prolonged movement time, lower peak velocity and departed from optimal bell-shaped velocity profiles. Their leftward strokes also showed prolonged accelerative phases, implying difficulties in force production, while the high proportion of their total movement time spent in decelerating with rightward strokes suggested an abnormal emphasis on terminal visual guidance.

- by James Phillips
- •
- Psychology, Cognitive Science, Attention, Cerebral Cortex

CIONI, B., ET AL.: Spinal Cord Stimulation (SCS) in Spastic Hemiparesis. Thirfeen patients with poststroke spastic hemiparesis underwent a percutaneous test trial of spinal cord stimulation fSCSJ in order to modify their motor disturbances. Clinical evaluation based on Albert's motor scale and neurophysioJogcial evaluation consisting of surface EMG during voJunfary, involuntary, and reflex motor activity were performed be/ore and during SCS. At the end of the test period, eight patients showed a signi/icanl improvement in their motor per/ormance. The EMG analysis confirmed the clinical data. SCS was followed by a reduction or disappearance of synergic coactivation with better agonist-antagonist coordination, a decrease of clonus both in duration and spreading, and better endurance. The e^ecf on motor controi did not increase with time after the first month o/SCS, but was long lasting (mean follow-up: 2 years). There was a correlation between sensory deficit and motor outcome suggesting that the enhancement a/sensory input put into piay by SCS and the consequent deveiopmeni of new sensory-motor integration might be responsible/or the improvement in mo(or performance. (PACE, Vol. 12, April Part II 1989} spinal cord stimulation, spasticity, stroke PACE, Vol. 12 April 1989, Part II

- by Giuseppe Talamonti
- •
- Biomedical Engineering, Spinal Cord, Hemiplegia, Electromyography

Golomb MR, McDonald BC, Warden SJ, Yonkman J, Saykin AJ, Shirley B, Huber M, Rabin B, AbdelBaky M, Nwosu ME, Barkat-Masih M, Burdea GC. In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy.... more

- by Moustafa AbdelBaky and +2
- •
- Technology, Occupational Therapy, Video Games, Magnetic Resonance Imaging

Background: Cognitive-motor interference, as measured by dual-task walking (performing a mental task while walking), affects many clinical populations. Ankle-foot orthoses (AFOs) are lower-leg splints prescribed to provide stability to the foot and ankle, as well as prevent foot drop, a gait deficit common after stroke. AFO use has been shown to improve gait parameters such as speed and step time, which are often negatively impacted by dual-task walking. Objectives: Our objective was to establish whether AFOs could protect against cognitive-motor interference, as measured by dual-task walking, following post-stroke hemiplegia. Methods: A total of 21 individuals with post-stroke hemiplegia that use an AFO completed a dual-task walking paradigm in the form of a 2 (walking with vs. without a concurrent cognitive task) by 2 (walking with vs. without an AFO) repeated-measures design. Changes to both motor and cognitive performance were analyzed. Results: The results suggest that the use of an AFO improves gait overall in both single-and dual-task walking, particularly with respect to stride regularity, but there were no interactions to suggest that AFOs reduce the cognitive-motor dual-task costs themselves. A lack of differences in cognitive performance during dual-task walking with and without the AFO suggests that the AFO's benefit to motor performance cannot be attributed to task prioritization. Conclusions: These data support the use of AFOs to improve certain gait parameters for post-stroke hemiplegia, but AFOs do not appear to protect against cognitive-motor interference during dual-task walking. Future research should pursue alternate therapeutics for ameliorating task-specific declines under cognitively demanding circumstances.

- by Kerry Clifton and +2
- •
- Cognitive Interference, Gait and Balance, Stroke, Hemiplegia

The purpose of this study was to establish test-retest reliability of measurement procedures for quantifying isokinetic concentric peak torque (PT) at the knee using normalization methods post-stroke. A second aim was to estimate the change required to show clinically significant improvements in knee muscles strength. The isokinetic normalized PT (NPT) values for the knee extensors and flexors were measured in each participant at two different angular velocities during two sessions 1 day apart. Thirty participants with mild to moderate hemiparesis after stroke who were able to walk were tested. The normalized PT measures for the knee muscles of the affected lower extremity were highly reliable (intraclass correlation coefficients ranged from 0.85 to 0.98; p < 0.05). Size of relative changes (the percent smallest real difference, SRD%) for extensors NPT (ranged from 22.35% to 25.68%) were lower than flexors NPT (ranged from 74.01% to 76.31%), indicating that the affected isokinetic knee flexors had more random variation than the knee extensors. This study supports the use of isokinetic dynamometers for the assessment of knee muscle strength in participants with chronic mild to moderate post-stroke hemiparesis and to measure clinical improvements. Established measurement error and smallest real differences in normalized PT will aid interpretation of real changes in muscle strength in this clinical population. #

- by Saeed Talebian
- •
- Mechanical Engineering, Skeletal muscle biology, Muscle strength, Stroke

Previous evidence has shown that active tool-use can reshape one's own body schema, extend peripersonal space and modulate the representation of related body parts. Here we investigate the effect of tool-use training on length representation of the contralesional forearm in brain-damaged hemiplegic patients who manifested a pathological embodiment of other people body parts. Four patients and 20 aged-matched healthy-controls were asked to estimate the mid-point of their contralesional forearm before and after 15 min of tool-use training (i.e. retrieving targets with a garbage plier). In the case of patients, training was always performed by the examiner's (alien) arm acting in two different positions, aligned (where the pathological embodiment occurs; Eþ condition) or misaligned (where the pathological embodiment does not occur; E À condition) relative to the patients' shoulder. Healthy controls performed tool-use training either with their own arm (action condition) or observing the examiner's arm performing the task (observation condition), handling (observation with-tool condition) or not (observation without-tool condition) a similar tool. Crucially, in the Eþ condition, when patients were convinced to perform the tool-use training with their own paralyzed arm, a significant overestimation effect was found (as in the Action condition with normal subjects): patients mislocated their forearm midpoint more proximally to the hand in the post-than in the pre-training phase. Conversely, in the E À condition, they did not show any overestimation effect, similarly to healthy subjects in the observation condition (neither in the with-tool nor in the without-tool condition significant overestimation effects were found). These findings show the existence of a tight link between spatial, motor and bodily representations and provide strong evidence that a pathological sense of body ownership can extend to intentional motor processes and modulate the sensory map of action-related body parts.

- by Marco Neppi-mòdona and +2
- •
- Psychology, Cognitive Science, Body Image, Space perception

Neuromuscular electrical stimulation (NMES) can be used to augment range-of-motion, strengthening, and facilitation treatment programs of the muscles surrounding the shoulder. The purposes of this article are 1) to describe the uses of NMES around the shoulder joint as developed through our clinical use and 2) to detail the effects of an NMES program on chronic shoulder subluxation as determined by a clinical study. Because of the complexities of this multiarticular joint, NMES is most useful in the initial phase of the ROM, and stimulated contractions are compromised, relatively, as the humerus moves above the 90-degree horizontal plane. The use of NMES to provide scapular stabilization often entails unwanted alteration of the pressures on the spinal column, occasionally making the treatment program unusable. Electrical stimulation to prevent or correct shoulder subluxation, especially in the neurologically involved patient, provides the therapist with a powerful new treatment tech...

- by Lucinda Baker
- •
- Exercise therapy, Physical Therapy, Movement, Hemiplegia

Objective. To assess the feasibility and reliability of ankle plantar¯exor stiness measurements in hemiplegia. Design. Repeated measurements in ®ve consecutive weeks. Background. In hemiplegia, an equinovarus positioning of the foot might... more

- by Jules Becher
- •
- Mechanical Engineering, Biomedical Engineering, Skeletal muscle biology, Elasticity

Viosca E, Lafuente R, Martínez JL, Almagro PL, Gracia A, González C. Walking recovery after an acute stroke: assessment with a new functional classification and the Barthel Index. Arch Phys Med Rehabil 2005;86:1239-44.

- by Jose Lopez Martinez
- •
- Physiotherapy, Treatment, Evolution, Gait

The energy cost of level walking (C,) was measured from the ratio of O2 consumption to speed (from 0.1 to 1.2 m-s-') in hemiplegic patients (n=20) and in a control group of healthy subjects (n=17). Average age and body mass were 58, 54 years and 73, 78 kg, respectively. In hemiplegic patients C, was higher than in control subjects (average value at 1 .O m-s-' =3.6 and 3.3 J.m-'.kg-', respectively) and this difference increased at lower speeds (from 5.1% at 1.2 m-s-' to 28.7% at 0.1 m.s-').

- by Paola Zamparo
- •
- Medicine, Energy Metabolism, Walking, Hemiplegia

Hesse S, Werner C, Paul T, Bardeleben A, Chaler J. Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. Arch Phys Med Rehabil 2001;82:1547-50.

- by Stefan Hesse and +1
- •
- Energy Consumption, Energy Metabolism, Gait, Walking

A method is derived to calculate the amount by which a subject's gait deviates from an average normal profile, and to represent this deviation as a single number. The method uses principal component analysis to derive a set of 16 independent variables from 16 selected gait variables. The sum of the square of these 16 independent variables is interpreted as the deviation of the subject's gait from normal. Statistical tests of the method's validity and an initial demonstration of its clinical utility are included. It is found that using this index, increasing clinical involvement corresponds to increasing index score.

- by Jean Stout and +3
- •
- Mechanical Engineering, Principal Component Analysis, Cerebral Palsy, Adolescent

To compare response to upper-limb treatment using robotics plus motor learning (ML) versus functional electrical stimulation (FES) plus ML versus ML alone, according to a measure of complex functional everyday tasks for chronic, severely impaired stroke survivors. Design: Single-blind, randomized trial. Setting: Medical center. Participants: Enrolled subjects (NZ39) were >1 year postsingle stroke (attrition rateZ10%; 35 completed the study). Interventions: All groups received treatment 5d/wk for 5h/d (60 sessions), with unique treatment as follows: ML alone (nZ11) (5h/d partial-and whole-task practice of complex functional tasks), robotics plus ML (nZ12) (3.5h/d of ML and 1.5h/d of shoulder/elbow robotics), and FES plus ML (nZ12) (3.5h/d of ML and 1.5h/d of FES wrist/hand coordination training). Main Outcome Measures: Primary measure: Arm Motor Ability Test (AMAT), with 13 complex functional tasks; secondary measure: upper-limb Fugl-Meyer coordination scale (FM). Results: There was no significant difference found in treatment response across groups (AMAT: P!.584; FM coordination: P!.590). All 3 treatment groups demonstrated clinically and statistically significant improvement in response to treatment (AMAT and FM coordination: P .009). A group treatment paradigm of 1:3 (therapist/patient) ratio proved feasible for provision of the intensive treatment. No adverse effects. Conclusions: Severely impaired stroke survivors with persistent (>1y) upper-extremity dysfunction can make clinically and statistically significant gains in coordination and functional task performance in response to robotics plus ML, FES plus ML, and ML alone in an intensive and long-duration intervention; no group differences were found. Additional studies are warranted to determine the effectiveness of these methods in the clinical setting.

- by Janis Daly
- •
- Robotics, Medicine, Stroke, Hemiplegia
- by Janis Daly
- •
- Robotics, Stroke, Hemiplegia, Clinical Sciences

Viosca E, Martínez JL, Almagro PL, Gracia A, González C. Proposal and validation of a new functional ambulation classification scale for clinical use. Arch Phys Med Rehabil 2005;86:1234-8. Objective: To validate a new functional... more

- by Pedro Almagro
- •
- Linear models, Stroke, Classification, Hemiplegia

This one-day workshop will introduce course participants to the Bayley-IIl. It will include an overview of the subtests, a broad look at the changes from BSID II, research design, psychometric properties, and special group studies. The Cognitive Scale, Language Scale, Motor Scale, Social-Emotional, and Adaptive Behaviour Scales will all be discussed. Administration and scoring procedures will be described and interpretative considerations discussed. The workshop is aimed at paediatric therapists, psychologists, paediatricians, and others responsible for assessing child development, who meet the criteria for a CL2 registration code with Harcourt Assessment.

- by Sérgio Fonseca
- •
- Skeletal muscle biology, Cerebral Palsy, Child, Movement
- by Torunn Askim
- •
- Cognitive Science, Pediatrics, Occupational Therapy, Traumatic Brain Injury

The aims of this study are to quantify the movement limitation of upper limbs in hemiplegic children with traumatic brain injury (TBI) by using a clinical-functional scale and upper limb kinematics and to evaluate the effectiveness of constraint-induced movement therapy (CIMT) on upper limbs. Design: Pre-post study. Setting: Clinical rehabilitation research laboratory. Participants: Ten children with TBI. Main Outcome Measures: The participants were evaluated by clinical examinations (Gross Motor Function Measure, Besta scale, Quality of Upper Extremities Skills Test, and Manual Ability Classification System) and 3D kinematic movement analysis of the upper limb before the CIMT program (pretest: 0.7 years after the injury) and at the end of the program (posttest: 10 weeks later). Results: After the CIMT, most of the clinical measures improved significantly. Some significant improvements were present in terms of kinematics, in particular, in the movement duration and the velocity of movement execution of both tasks; the index of curvature and the average jerk improved, respectively, during reaching and hand-to-mouth task, while the adjusting sway parameter decreased during the 2 movements. Significant improvements were found in upper limb joint excursion after the rehabilitative programme too. Conclusions: Our results suggest that the CIMT program can improve movement efficiency and upper limb function in children after TBI. The integration of the clinical outcomes and upper limb kinematics revealed to be crucial in detecting the effects of the CIMT programme.

The objective of this study is to review the available literature on elbow orthoses in patients with various diagnoses to assess the scientific base of the prescription of elbow orthoses. A search of literature 'in Medline, Embase, Cochrane and Recal was performed using the keyword "elbow" combined with "orthosis related keywords". Abstracts were read to select the papers dealing primarily with monoarticular elbow orthoses. References of the selected papers were also examined. A total of 57 papers were read of which 18 met the selection criteria. Both the quality and quantity of the studies appeared to be low, so in this study no definitive conclusions can be drawn about the efficacy of monoarticular elbow orthoses. Current prescriptions of elbow orthoses cannot be evidence based, because no scientific evidence on elbow orthoses is available.

- by Juha Hijmans
- •
- Biomedical Engineering, Pain, Pain Management, Stroke
- by Lena Krumlinde-Sundholm
- •
- Adolescent, Child, Touch, Hemiplegia
- by Pouran Faghri
- •
- Hand Therapy, Hemiplegia, Clinical Sciences, Aged
- by Jill Whitall
- •
- Engineering, Motor Control, Exercise therapy, Human Movement Science

In the present paper, we review the main concepts of the dynamical systems approach to bimanual coordination and propose applications to therapeutic intervention for functional recovery of coordinated movements in stroke. Further, we describe the behavioral alterations of discrete bimanual coordination resulting from cerebral vascular accident (CVA) lesions and speculate on the possibility of mimicking the mechanisms of CVA lesions via symmetry breaking in dynamic systems.

- by E. Berton
- •
- Nonlinear dynamics, Attention, Multidisciplinary, Intention

measurement. 7bepurpose of th & desc@tive study was to quantzfi the work that & accomplished by major muscle groups of the afected limb of 10 children with spasic herniplegia secondaty to cerebral palsy during walking. Cinematographic film and fmceplate data were used in a biomecbanical lid-segment model to calculate the positive Gait analysis of chldren with cerebral palsy (CP) has been used to study the basic biomechanics of their walking, which, in turn, has assisted in thera-peutic and surgical decision making.l-6 Recent developments in the technol-ogy used in gait analysis and the ready availability of high-speed com-puters at modest cost have made possible certain analyses that were known but not feasible. One of these analyses is the determination of instantaneous power and work accomplished by the muscle groups crossing major joints.

- by Sandra J Olney
- •
- Cerebral Palsy, Medicine, Physical Therapy, Energy Metabolism

Stroke survivors present a less efficient gait compared to healthy subjects due to abnormal knee flexion during the swing phase of gait, associated with spasticity of the rectus femoris muscle and overactivity of the ankle plantarflexors. It is relevant to understand the effect of the ankle foot orthosis (AFO) on gait in individuals with plantarflexor spasticity. The aim of this study was to compare the knee kinematics with an AFO/footwear combination and barefoot in post-stroke subjects with plantarflexor spasticity.

- by Lisandro Olmos and +1
- •
- Mechanical Engineering, Biomedical Engineering, Biomechanics, Gait

Rev Neurocienc 2012;20(1):42-49 original 42 RESUMO Objetivo. O objetivo deste estudo foi avaliar a função motora dos pacientes com acidente vascular cerebral, e correlacionar idade e tempo de tratamento com o comprometimento motor através do protocolo de desempenho Físico de Fugl-Meyer. Método. Participaram 20 pacientes, com idade acima de 45 anos, sendo aplicado o protocolo de Fulg-meyer. Resultados. No estudo, 65% eram do sexo masculino, com média de idade de 65,95 anos. A amplitude articular estava diminuída em 70% dos pacientes, 30% apresentavam sensibilidade normal e 55% referiam alguma dor à movimentação passiva. Foi observado que 95% tinham diminuição da motricidade de membro superior e 40% no membro inferior. Os pacientes apresentaram grau de comprometimento motor severo (35%) e marcante (65%). Conclusão. Não foi visto correlação do grau de comprometimento motor com a idade e com o tempo de tratamento. Unitermos. Reabilitação, Acidente Vascular Cerebral, Hemiplegia. Citação. Teles MS, Gusmão C. Avaliação funcional de pacientes com Acidente Vascular Cerebral utilizando o protocolo de Fugl-Meyer.

- by Sabrina Brandão
- •
- Hemiplegia, Acidente Vascular Cerebral

With an ageing population in an industrialised world, the global burden of stroke is staggering (millions of strokes a year). Hemiparesis is one of the most common and disabling sequelae of stroke. In patients with immobile phantom limbs after amputation, vivid kinaesthetic sensations of movement can be evoked when the patient watches movement of the non-amputated hand or arm in a vertical parasagittal mirror. 1 Encouraged by a good initial result, 2 we have now done a larger trial of mirror therapy on patients with hemiparesis following stroke.

- by Chris Foster
- •
- Computed Tomography, Informed Consent, Medicine, Hemiplegia

A new standing biofeedback training device, which includes a height-adjustable work table, weight-bearing sensors, and a real-time visual and auditory feedback system, has been developed for postural training . Sixty persons with hemiplegia after acute stroke or traumatic brain injury were randomly divided into Group A (experimental) and Group B (control) . After a training period of 4 weeks, the percentage of postural asymmetry in Group A and Group B was reduced from 17.2±10.8% and 17.0±10 .0% to 3.5±2 .2% and 10.1±6 .4 percent, respectively (p=0 .003) . There was no significant difference between subjects with right or left hemiplegia . The results indicated that this device had a positive training effect on stance symmetry in hemiplegic subjects.

- by Alice Wong
- •
- Development, Hemiplegia, Posture, Clinical Sciences

This study has focused upon the automatic components of posture and movement in a group of ten cerebral palsy children carefully selected to represent a spectrum of abnormalities relatively pure by clinical standards and ten age-matched normals. Each subject stood unsupported upon a movable platform and within a movable visual surround and was then exposed to external perturbations or was asked to pull with one arm upon a movable handle. In comparing the performance of cerebral palsy children in each clinical category with the agematched normals and with normal adults assessed in previous studies, the process of maintaining stance was subdivided into two component functions: substrates which determined the onset timing, direction and amplitude of postural actions from somatosensory, vestibular, and visual stimuli were termed "sensory organization", and those establishing temporal and spatial patterns of muscular contractions appropriate to produce effective movements were termed "muscle coordination". We found among seven of the ten cerebral palsy children a clear localization of dysfunction within either sensory organization or muscle coordination mechanisms. These results are providing some new insights into the organization of each of these processes as well as suggesting methods for developing a more systematic understanding of the abnormalities of movement control.

- by L. Nashner
- •
- Motor Development, Cerebral Palsy, Postural Control, Child
- by Kaat Desloovere and +2
- •
- Pathology, Psychology, Biomechanics, Cerebral Palsy

Following right-hemisphere damage, a specific disorder of motor awareness can occur called anosognosia for hemiplegia, i.e. the denial of motor deficits contralateral to a brain lesion. The study of anosognosia can offer unique insights into the neurocognitive basis of awareness. Typically, however, awareness is assessed as a first person judgement and the ability of patients to think about their bodies in more 'objective' (third person) terms is not directly assessed. This may be important as right-hemisphere spatial abilities may underlie our ability to take third person perspectives. This possibility was assessed for the first time in the present study. We investigated third person perspective taking using both visuospatial and verbal tasks in right-hemisphere stroke patients with anosognosia (n = 15) and without anosognosia (n = 15), as well as neurologically healthy control subjects (n = 15). The anosognosic group performed worse than both control groups when having to perform the tasks from a third versus a first person perspective. Individual analysis further revealed a classical dissociation between most anosognosic patients and control subjects in mental (but not visuospatial) third person perspective taking abilities. Finally, the severity of unawareness in anosognosia patients was correlated to greater impairments in such third person, mental perspective taking abilities (but not visuospatial perspective taking). In voxel-based lesion mapping we also identified the lesion sites linked with such deficits, including some brain areas previously associated with inhibition, perspective taking and mentalizing, such as the inferior and middle frontal gyri, as well as the supramarginal and superior temporal gyri. These results suggest that neurocognitive deficits in mental perspective taking may contribute to anosognosia and provide novel insights regarding the relation between self-awareness and social cognition.

- by Stephanie Forkel
- •
- Psychology, Cognition, Theory of Mind, Agnosia

Attenuation of cerebral evoked responses after stimulation of the median nerve in the hemiplegic limbs suggested that an apparently pure motor hemiplegia in some patients may not have pure involvement of the corticospinal system. Frontoparietal metastasis, infarction in basis pontis and medullary pyramid, and occlusion of internal carotid artery in the neck resulted in pure motor hemiplegia in some individuals.

- by Frank Rubino
- •
- Electroencephalography, Brain, Evoked Potentials, Hemiplegia

This report, part I of a two-part case report on the clinical use of neuromuscular electrical stimulation (NMES) for children with cerebral palsy, documents the func-tional changes that occurred with the application of NMES to the lower... more

- by judy carmick
- •
- Locomotion, Cerebral Palsy, Medicine, Physical Therapy

Balance problems are a major sequelae of stroke and are implicated in poor recovery of activities of daily living. In a cross-sectional study, using 50-channel event-related functional near-infrared spectroscopy we previously reported a significant correlation between individual balance ability after stroke and postural perturbation-related cortical activation in the supplementary motor area (SMA) and the prefrontal cortex. However, the neural mechanisms underlying balance recovery after stroke remain unclear. Herein, we examined the cortical involvement in balance recovery after stroke by determining longitudinal regional cortical activation changes in patients with hemiplegic stroke. Twenty patients with subcortical stroke admitted to our hospital for post-acute inpatient rehabilitation participated in this study. Before and after intensive inpatient physical and occupational therapy rehabilitation, we evaluated cortical activation associated with external postural perturbations induced by combined brisk forward and backward movement on a platform. Postural perturbation-related cortical activation in the SMA of the affected and unaffected hemispheres was significantly increased after intensive rehabilitation. The increment of the postural-perturbation-related oxygenated hemoglobin signals in the SMA of the unaffected hemisphere was significantly correlated with the gain in balance function measured by the Berg Balance Scale. These findings support the conclusion that the SMA plays an important role in postural balance control, and suggest that the SMA is a crucial area for balance recovery after hemiplegic stroke.

- by Hideki Mochizuki and +1
- •
- Linear models, Stroke, Cerebral Cortex, Near Infrared Spectroscopy
- by Alice Wong
- •
- Stroke rehabilitation, Stroke, Prospective studies, Hemiplegia

The aim of the study was to identify factors affecting the progress in physical abilities and activities of daily living of patients admitted to a stroke unit. A series of 70 patients admitted consecutively were assessed on a series of tests of motor, functional and cognitive abilities at admission. They were assessed for level ofmotor abilities and activities ofdaily living at discharge and 9 months after stroke. Predictive equations were developed which account for between 61% and 33 % of the variance in motor abilities and activities of daily living at discharge and at 9 months after stroke. The most important factor influencing outcome was the degree of motor loss.

- by Judi Edmans
- •
- Neurology, Aphasia, Activities of Daily Living, Hemiplegia

Objective: To assess the ability of the Wisconsin Gait Scale to evaluate qualitative features of changes in hemiplegic gait in post-stroke patients. Design: A prospective observational study. Subjects: Ten healthy subjects and 56 hemiplegic outpatients, more than 12 months post-stroke, consecutively admitted in a rehabilitation centre. Methods: Patients were videotaped while walking at a comfortable speed. Quantitative and clinical gait parameters were derived from videotaped walking tasks at admission and at the end of a period of rehabilitation training. Qualitative features were assessed using the Wisconsin Gait Scale. Functional status was rated through the modified Barthel Index. Results: After training, the median Wisconsin Gait Scale score improved significantly (28 vs 26.5; p = 0.003). In particular, "weight shift to paretic side" and patterns during the swing phase of the affected leg were improved. Gait velocity (0.3 vs 0.4 m/sec; p = 0.001) and stride length (77 vs 85 cm; p = 0.0002) increased significantly, whereas number of steps (25 vs 23; p = 0.004), stride period (2.5 vs 2.3 sec; p = 0.04), and stance period (2.1 vs 2 sec; p = 0.03) of the unaffected side were reduced. The Barthel Index score increased (71 vs 78; p = 0.005). Conclusion: The Wisconsin Gait Scale is a useful tool to rate qualitative gait alterations of post-stroke hemiplegic subjects and to assess changes over time during rehabilitation training. It may be used when a targeted and standardized characterization of hemiplegic gait is needed for tailoring rehabilitation and monitoring results.

- by Giovanna Carlucci and +2
- •
- Rehabilitation Medicine, Gait, Stroke, Walking

The authors' purposes are to 1) discuss the physiologic effects of cold on the body, 2) review the literature on cryotherapy, 3) examine the benefits and the limitations of the use of cold, and 4) stimulate interest in further clinical and laboratory research. The results of this literature investigation suggest that cold can be beneficial in the treatment of patients with a wide variety of neurologic and musculoskeletal conditions, although uniform guidelines have not yet been established. Cryotherapy is the local or systemic application of cold for therapeutic purposes. The use of cold in medicine is prehistoric; it is predated perhaps only by its sister therapy, heat. Throughout the ages, controversy has existed about the relative therapeutic value of heat versus cold. Hippoc rates recommended the application of cold to recent injuries, whereas Galen used only warm water and oil in his treatment regimen. 1 The therapeutic value of heat versus cold is still a controversial issue. Interest in cryother apy has increased in recent years; however, clinical decisions to use cold therapy continue to be based on the subjective feeling by the patient, the impression of the observer, and the subsequent course of the pathology rather than on pertinent research data.

- by Vincent Stravino
- •
- Multiple sclerosis, Rheumatoid Arthritis, Cerebral Palsy, Physical Therapy

One of the most troublesome complications in the rehabilitation of hemiplegic patients is inferior subluxation of the glenohumeral joint. The purpose of this study was to determine which of two shoulder supports, the Bobath shoulder roll or the Henderson shoulder ring, would be more effective in the management of hemiplegic patients with a subluxated glenohumeral joint. To determine the degree of subluxation and the amount of reduction after application of a shoulder support, radiographs were taken of 26 hemiplegic patients with subluxated shoulders. Radiographs of the unsupported affected shoulder were compared with radiographs of the same shoulder with each support applied. Radiographs of the unaffected shoulder were used as a comparison in determining the amount of subluxation. An analysis of variance revealed no significant difference in the reduction of inferior subluxation between the two types of shoulder support. A significant difference in subluxation, however, existed between measurements of the unsupported affected shoulder and the unaffected shoulder (p < .001) and between measurements of the unsupported affected shoulder and the supported affected shoulder (p < .001). The results of this study demonstrate the benefits of the Bobath shoulder roll and the Henderson shoulder ring in the management of hemiplegic patients with subluxated shoulders.

- by Terry Minuk
- •
- Physical Therapy, Hemiplegia, Clinical Sciences, Aged

Seventy-four hemiplegic patients (31 female and 43 male) participated in this study. The average (AEstandard deviation) age, mass and height of the participants were as follows: 55.6 AE 9.4 and 58.9 AE 9.3 years, 69.6 AE 11.6 and 78.7 AE 9.9 kg, 162 AE 5 and 173.8 AE 5.2 cm (females and males, respectively). Fifty-five were diagnosed with ischemic stroke, 20 with hemorrhagic stroke. The inclusion criteria were: age 40-70 years, first incident of hemorrhagic or ischemic stroke within the past six months, capable of walking independently using no aids, with no other disorders of an orthopedic, rheumatologic, etc., nature that could affect gait kinematics and no cognitive disorders. Participants and their physicians and physiotherapists provided consent for their participation in this study. The sample size, 74, consisted of all patients treated by the host institution in 2005-2007 who met these inclusion criteria.

- by Andrzej Wit and +1
- •
- Mechanical Engineering, Stroke, Discriminant Analysis, Hemiplegia

Feedback about motor performance can induce either an internal focus of attention (about body movement) or an external focus of attention (about the effects on the environment) in the learner. The main aim of this pilot study was to examine the attentional focus of feedback given by physiotherapists during treatment of the hemiplegic arm. A second aim was to examine the frequency of feedback about motor performance during treatment. A multi-methods design was used (quantitative and qualitative). Eight physiotherapists and eight patients with stroke were recruited from two hospitals. Data were collected by video recordings of treatment, interviews (both therapists and patients) and questionnaire (therapists). Information feedback, instructions and motivational statements were identified from the video recordings. Feedback and instructions were further grouped into internal focus, external focus or mixed focus of attention. Themes were drawn from the interview transcripts. Triangulation was used to provide corroborating information from the different data sets. Two hundred and forty-six of the total 1914 statements identified in the videos were feedback, the rest comprising instructions and statements of motivation. Of the feedback statements, 236 of the total 247 identified had an internal focus. Therapist interviews and questionnaires revealed more external focus communication than actual treatment. Physiotherapists used instructions and statements of motivation more than feedback and directed the patient&amp;amp;amp;amp;amp;amp;amp;#39;s attention more to body movement than movement effects. The outcome of this study may prompt clinicians&amp;amp;amp;amp;amp;amp;amp;#39; to examine the amount and the attentional focus of the feedback they use in their clinical practice, and to consider whether it is a most effective approach in light of current evidence.

- by Paulette Van Vliet
- •
- Physiotherapy, Attention, Motivation, Stroke