Influence of Task on Interlimb Coordination in Adults With Cerebral Palsy

Langan J, Doyle ST, Hurvitz EA, Brown SH. Influence of task on interlimb coordination in adults with cerebral palsy.

Objective

To examine movement time and kinematic properties of unilateral and bilateral reaching movements in adults with cerebral palsy (CP), focusing on how different types of bilateral movements, simultaneous or sequential, may influence interlimb coordination.

Design

Quantitative study using between-group repeated-measures analyses.

Setting

Motor control laboratory at a research university.

Participants

Adults with hemiplegic CP (n=11; mean age ± SD, 33±10y; 4 men) and age-matched controls (mean age ± SD, 32±9y; 4 men).

Interventions

Not applicable.

Main Outcome Measures

Movement time (MT), maximum deviation from a straight trajectory to the target, and peak speed.

Results

Although adults with hemiplegic CP showed strong unilateral deficits, bilateral simultaneous reaching movements were temporally and spatially coupled. Movement of the less affected arm slowed to match the movement of the more affected arm. In contrast, bilateral sequential movements improved MTs of the less affected and more affected arms.

Conclusions

Bilateral sequential movements were conducive to faster MT compared with unilateral or bilateral simultaneous movements. Training that includes bilateral sequential movements may be beneficial to adults with hemiplegic CP. Upper-limb movements are coordinated in a variety of ways to perform routine bilateral tasks. Some bilateral tasks, such as stacking boxes, require more symmetric movements of the upper limbs. Other bilateral tasks, such as opening the refrigerator with 1 hand while placing an item on the shelf with the other hand, emphasize coordinated sequential action between upper limbs. Despite the prevalence of integrative upper-limb use, the control of different forms of bilateral movement is not well understood. A more comprehensive knowledge of upper-limb bilateral movements may hold important implications for developing more effective upper-limb movement therapies.     

Repeated treatments with botulinum toxin type a produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients

Elovic EP, Brashear A, Kaelin D, Liu J, Millis SR, Barron R, Turkel C. Repeated treatments with botulinum toxin type A produce sustained decreases in the limitations associated with focal upper-limb poststroke spasticity for caregivers and patients.

Objective

To assess the safety and evaluate the effects of repeated treatments with botulinum toxin type A (BTX-A) on functional disability, quality of life (QOL), and muscle tone of patients with upper-limb poststroke spasticity, as well as its effect on caregivers.

Design

Multicenter, open-label, repeated-dose study.

Setting

Thirty-five clinical sites in North America.

Participants

Patients (N=279) with upper-limb poststroke spasticity at 6 months or more poststroke.

Intervention

Up to 5 intramuscular injections of BTX-A (200-400U) divided among the wrist, finger, thumb, and elbow flexors, with at least 200U in the wrist and finger flexors. Retreatment was permitted at 12 weeks or more after the last treatment.

Main Outcome Measures

Investigators rated disability using the Disability Assessment Scale and muscle tone using the Ashworth Scale. Each patient's health-related QOL was assessed by using the Stroke Adapted Sickness Impact Profile and the visual analog scale of the European Quality of Life−5 Dimensions questionnaires.

Results

Patients treated with BTX-A reported improvements in muscle tone, disability, and ability to function that were statistically significant and clinically meaningful. Significant improvements were observed at week 30 and at subsequent time points in QOL in the overall group and the high-dose group.

Conclusions

Up to 5 treatments with BTX-A every 12 weeks for up to 56 weeks in patients with poststroke spasticity was well tolerated and significantly improved muscle tone, lessened disability, and improved patients' QOL. Further research is required to examine the effectiveness of repeated injections of BTX-A in patients with poststroke spasticity.     

Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke

Yu E, Abe M, Masani K, Kawashima N, Eto F, Haga N, Nakazawa K. Evaluation of postural control in quiet standing using center of mass acceleration: comparison among the young, the elderly, and people with stroke.

Objective

To determine center of mass (COM) acceleration usefulness in the evaluation of postural control during quiet standing.

Design

Three-group comparison design.

Setting

A research laboratory.

Participants

Poststroke subjects (n=12), healthy elderly subjects (n=22), and healthy young subjects (n=25).

Interventions

Not applicable.

Main Outcome Measures

With a force platform, postural sway was evaluated by using the standard deviations of COM acceleration and center of pressure (COP) and COM (COP-COM) in which COP-COM represents the distance between the COP and the COM.

Results

COM acceleration and COP-COM variables were greater in the poststroke group than in the healthy groups (elderly and young) in the mediolateral (ML) direction. Both variables in the anteroposterior (AP) direction were greater in the poststroke group and the elderly group than in the young group. Furthermore, the correlations between COM acceleration and COP-COM in each group in each direction were shown to be significantly high (r range, .906-.979; P<.001).

Conclusions

COM acceleration was useful in the evaluation of postural control during quiet standing when comparing the young, the elderly, and poststroke patients. Additionally, COM acceleration and COP-COM in both the AP and ML directions during quiet standing were significantly and highly correlated. Thus, we proposed that COM acceleration can be an alternative and convenient measure instead of COP-COM in the evaluation of postural control.     

A 1-Year Follow-Up After Shortened Constraint-Induced Movement Therapy With and Without Mitt Poststroke

Brogårdh C, Lexell J. A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke.

Objective

To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke.

Design

A 1-year follow-up after shortened CIMT (3h training/d for 2wk) where the participants had been randomized to a mitt group or a nonmitt group.

Setting

A university hospital rehabilitation department.

Participants

Poststroke patients (N=20, 15 men, 5 women; mean age 58.8y; on average 14.8mo poststroke) with mild to moderate impairments of hand function.

Interventions

Not applicable.

Main Outcome Measures

The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers.

Results

One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time.

Conclusions

Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.     

The Influence of Applying Additional Weight to the Affected Leg on Gait Patterns During Aquatic Treadmill Walking in People Poststroke

Jung T, Lee D, Charalambous C, Vrongistinos K. The influence of applying additional weight to the affected leg on gait patterns during aquatic treadmill walking in people poststroke.

Objective

To investigate how the application of additional weights to the affected leg influences gait patterns of people poststroke during aquatic treadmill walking.

Design

Comparative gait analysis.

Setting

University-based aquatic therapy center.

Participants

Community-dwelling volunteers (n=22) with chronic hemiparesis caused by stroke.

Interventions

Not applicable.

Main Outcome Measures

Spatiotemporal and kinematic gait parameters.

Results

The use of an ankle weight showed an increase in the stance phase percentage of gait cycle (3%, P=.015) when compared with no weight. However, the difference was not significant after a Bonferroni adjustment was applied for a more stringent statistical analysis. No significant differences were found in cadence and stride length. The use of an ankle weight showed a significant decrease of the peak hip flexion (7.9%, P=.001) of the affected limb as compared with no weight condition. This decrease was marked as the reduction of unwanted limb flotation because people poststroke typically show excessive hip flexion of the paretic leg in the late swing phase followed by fluctuating hip movements during aquatic treadmill walking. The frontal and transverse plane hip motions did not show any significant differences but displayed a trend of a decrease in the peak hip abduction during the swing phase with additional weights. The use of additional weight did not alter sagittal plane kinematics of the knee and ankle joints.

Conclusions

The use of applied weight on the affected limb can reduce unwanted limb flotation on the paretic side during aquatic treadmill walking. It can also assist the stance stability by increasing the stance phase percentage closer to 60% of gait cycle. Both findings can contribute to the development of more efficient motor patterns in gait training for people poststroke. The use of a cuff weight does not seem to reduce the limb circumduction during aquatic treadmill walking.     

The role of order of practice in learning to handle an upper-limb prosthesis

Bouwsema H, van der Sluis CK, Bongers RM. The role of order of practice in learning to handle an upper-limb prosthesis.

Objective

To determine which order of presentation of practice tasks had the highest effect on using an upper-limb prosthetic simulator.

Design

A cohort analytic study.

Setting

University laboratory.

Participants

Healthy, able-bodied participants (N=72) randomly assigned to 1 of 8 groups, each composed of 9 men and 9 women.

Interventions

Participants (n=36) used a myoelectric simulator, and participants (n=36) used a body-powered simulator. On day 1, participants performed 3 tasks in the acquisition phase. On day 2, participants performed a retention test and a transfer test. For each simulator, there were 4 groups of participants: group 1 practiced random and was tested random, group 2 practiced random and was tested blocked, group 3 practiced blocked and was tested random, and group 4 practiced blocked and was tested blocked.

Main Outcome Measures

Initiation time, the time from the starting signal until the beginning of the movement, and movement time, the time from the beginning until the end of the movement.

Results

Movement times got faster during acquisition (P<.001). The blocked group had faster movement times (P=.009), and learning in this group extended over the complete acquisition phase (P<.001). However, this advantage disappeared in the retention and transfer tests. Compared with a myoelectric simulator, movements with the body-powered simulator were faster in acquisition (P=.004) and transfer test (P=.034).

Conclusions

Performance in daily life with a prosthesis is indifferent to the structure in which the training is set up. However, practicing in a blocked fashion leads to faster performance; in novice trainees, it might be suggested to practice part of the training tasks in blocks.     

Estimating minimal clinically important differences of upper-extremity measures early after stroke

Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke.

Objective

To estimate minimal clinically important difference (MCID) values of several upper-extremity measures early after stroke.

Design

Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial, an acute, single-blind randomized controlled trial of constraint-induced movement therapy. Subjects were tested at the prerandomization baseline assessment (average days poststroke, 9.5d) and the first posttreatment assessment (average days poststroke, 25.9d). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests.

Setting

Inpatient rehabilitation hospital.

Participants

Fifty-two people with hemiparesis poststroke.

Interventions

Not applicable.

Main Outcome Measures

Estimated MCID values for grip strength, composite upper-extremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upper-extremity use as measured with accelerometry.

Results

MCID values for grip strength were 5.0 and 6.2kg for the affected dominant and nondominant sides, respectively. MCID values for the ARAT were 12 and 17 points, for the WMFT function score were 1.0 and 1.2 points, and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides, respectively. MCID values were indeterminate for the dominant (composite strength), the nondominant (WMFT time score), and both affected sides (duration of use) for the other measures.

Conclusions

Our data provide some of the first estimates of MCID values for upper-extremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke.     

Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial

Shields N, Taylor NF, Dodd KY. Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial.

Objective

To determine whether progressive resistance training improves muscle strength, muscle endurance, and physical function in adults with Down syndrome.

Design

Single-blind randomized controlled trial.

Setting

General community.

Participants

Adults (N=20) with Down syndrome (13 men, 7 women; mean age, 26.8±7.8y) were randomly assigned through a concealed allocation block randomized method to either an intervention group (n=9) or a control group (n=11).

Intervention

The intervention was a supervised, group progressive resistance training program, consisting of 6 exercises using weight machines performed twice a week for 10 weeks. Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue. The control group continued with their usual activities.

Main Outcome Measures

The outcomes measured by blinded assessors were muscle strength (1-repetition maximum [1-RM]), muscle endurance (number of repetitions at 50% of 1-RM) for chest press and leg press, timed stairs test, and the grocery shelving task.

Results

The intervention group showed significant improvement in upper-limb muscle endurance compared with the control group (mean difference in the number of repetitions of the chest press at 50% of 1-RM was 16.7, 95% confidence interval, [CI] 7.1-26.2); and a trend toward an improvement in upper-limb muscle strength (mean difference in chest press 1-RM, 8.6kg; 95% CI, −1.3 to 18.5kg) and in upper-limb function (mean difference in grocery shelving task, −20.3s; 95% CI, −45.7 to 5.2s). There were no significant differences between the groups for lower-limb muscle performance or physical function measures. No major adverse events for the intervention were noted.

Conclusions

Progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome (ACTR identifier ACTRN 012606000515594.)     

Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial

Bürge E, Kupper D, Finckh A, Ryerson S, Schnider A, Leemann B. Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial.

Objective

To quantify the preventive effect of a neutral functional realignment orthosis on pain, mobility, and edema of the hand in subacute hemiparetic poststroke patients with severe motor deficits.

Design

Randomized trial.

Setting

Rehabilitation center.

Participants

Poststroke patients (N=30) with subacute hemiparesis and severe deficits of the upper limb were enrolled. Fifteen patients were randomized to a standard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their standard rehabilitation program.

Intervention

The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily.

Main Outcome Measures

Hand pain at rest (visual analog scale), wrist range of motion (Fugl-Meyer Assessment subscale), and edema of hand and wrist (circumferences). Outcome measures were assessed at time of randomization and after 13 weeks between groups.

Results

At baseline, 2 patients in each group complained about a painful hand. After 13 weeks, 8 subjects in the control group and 1 subject in the orthosis group complained of hand pain (P=.004). Mobility and edema evolved similarly in both groups.

Conclusions

Neutral functional realignment orthoses have a preventive effect on poststroke hand pain, but not on mobility and edema in the subacute phase of recovery.     

Use of a Combination of Ankle Pressure and SENSERite System to Treat Older Adults With Impaired Ankle Proprioception: A Single-Blind Experimental Study

You JH, Saliba S, Saliba E. Use of a combination of ankle pressure and SENSERite system to treat older adults with impaired ankle proprioception: a single-blind experimental study.

Objective

To investigate the effects of a combination of visual biofeedback and ankle pressure on ankle position sense in elderly adults with and without impaired ankle joint position sense (JPS).

Design

Independent 2 × 3 factorial design with an experimenter-blind study.

Setting

University motion laboratory.

Participants

Older adults (N=40) were recruited from local community centers. Among them, 21 elderly subjects had relatively normative score, whereas 19 subjects had impaired ankle position sense.

Intervention

Both the normative and impaired elderly subjects underwent either ankle JPS visual feedback training alone or a combination of ankle JPS visual feedback training and circumferential ankle pressure for one 30-minute training session.

Main Outcome Measures

The outcome measures included ankle JPS errors measured in absolute constant error (ACE) and variable error (VE) during standing at pretest, posttest, and 1-week follow-up test. A separate repeated measures analyses of variance was performed to evaluate the differential training effects on ACE and VE, respectively. The Pearson chi-square test and Bonferroni test were performed. Significance was assigned at P less than .05 for all analyses.

Results

Regardless of intervention conditions, older adults with and without ankle position sense impairment showed immediate treatment benefits, which relatively remained stable even at the follow-up test. These effects were reflected in significant improvements of JPS accuracy and consistency (P<.05).

Conclusions

Our findings may suggest that both interventions were equally effective in increasing ankle JPS accuracy and consistency in older adults with and without impairments, and therapeutic effects lasted for a week, reflecting long-term effect.     

Therapeutic effectiveness of electric stimulation of the upper-limb poststroke using implanted microstimulators

Turk R, Burridge JH, Davis R, Cosendai G, Sparrow O, Roberts HC, Hughes A-M, Schulman J. Therapeutic effectiveness of electric stimulation of the upper-limb poststroke using implanted microstimulators.

Objective

To investigate the therapeutic effect of functional exercise augmented by programmable implanted microstimulators on arm and hand function.

Design

Before and after study.

Setting

Implantation was performed in a neurosurgery unit, systems were programmed, and tests were conducted in a university laboratory and subjects exercised at home.

Participants

Hemiparetic subjects (N=7) with reduced upper-limb function who were at least 12 months poststroke were recruited from the community. No subjects withdrew.

Intervention

Microstimulators were implanted into the arms and forearms to activate elbow, wrist, and finger extension, and thumb abduction. After training and programming of the system, subjects underwent 12 weeks of functional home-based exercise with stimulation.

Main Outcome Measures

The primary functional measure was the Action Research Arm Test (ARAT). Impairment measures included upper-limb Fugl-Meyer Assessment (FMA) and tests of motor control (tracking index), spasticity (electromyography stretch index) strength, and active range of motion (AROM). The assessor was not blinded, but scores were validated by an independent blinded observer.

Results

All subjects were able to perform functional activities at home by using the system. Compliance was excellent, and there were no serious adverse events. Statistically significant improvements were measured (P<.05) in the tracking index (57.3°²±48.65°²), FMA score (6.3±3.59), wrist-extensor strength (5.5±4.37N), and wrist AROM (19.3°±18.96°). The mean improvement in ARAT score ± SD of 4.9±7.89 was not statistically significant.

Conclusions

This study has shown the feasibility of a programmable implanted microstimulator system used at home to perform functional exercises and a reduction in impairment after 12 weeks.     

Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease

Putt MT, Watson M, Seale H, Paratz JD. Muscle stretching technique increases vital capacity and range of motion in patients with chronic obstructive pulmonary disease.

Objectives

To determine if a specific hold and relax stretching technique was capable of (1) reversing the effect of tight chest wall muscles by increasing chest expansion, vital capacity, and shoulder range of motion and (2) decreasing perceived dyspnea and respiratory rate in persons with chronic obstructive pulmonary disease (COPD).

Design

Double-blind crossover trial.

Setting

A physiotherapy department at a major metropolitan hospital.

Participants

Fourteen stable patients with COPD who had recently completed a pulmonary rehabilitation program were enrolled, with 10 patients completing the study.

Intervention

A hold and relax stretching technique of the pectoralis major and a sham technique each for 2 days.

Main Outcome Measures

The primary outcome measure was vital capacity (VC), with secondary outcome measures being perceived dyspnea, axillary (ACE) and xiphisternal chest expansion (XCE), right and left shoulder horizontal extension, and respiratory rate.

Results

The hold and relax technique to the pectoralis major compared with the sham technique produced significant effects on VC (P<.01), and right (P<.01) and left (P<.05) upper-limb range of motion. There was no significant effect on ACE, XCE, perceived dyspnea, or respiratory rate. There was no order effect for either technique.

Conclusions

The hold and relax technique produces short-term benefits in patients with COPD and should be investigated further.     

Demographic and Clinical Variation in Veterans Health Administration Provision of Assistive Technology Devices to Veterans Poststroke

Hubbard Winkler SL, Cowper Ripley DC, Wu S, Reker DM, Vogel B, Fitzgerald SG, Mann WC, Hoenig H. Demographic and clinical variation in Veterans Health Administration provision of assistive technology devices to veterans poststroke.

Objectives

To examine variation in provision of assistive technology (AT) devices and the extent to which such variation may be explained by patient characteristics or Veterans Health Administration (VHA) administrative region.

Design

Retrospective population-based study.

Setting

VHA.

Participants

Veterans poststroke in fiscal years 2001 and 2002 (N=12,046).

Interventions

Not applicable.

Main Outcome Measure

Provision of 8 categories of AT devices.

Results

There was considerable regional variation in provision of AT. For example, differences across administrative regions in the VHA ranged from 5.1 to 28.1 standard manual wheelchairs per 100 veterans poststroke. Using logistic regression, with only demographic variables as predictors of standard manual wheelchair provision, the c statistic was .62, and the pseudo R² was 2.5%. Adding disease severity increased the c statistic to .67 and the pseudo R² to 6.2%, and adding Veteran Integrated Network System further increased the c statistic to .72 and pseudo R² to 9.8%.

Conclusions

Our research showed significant variation in the provision of AT devices to veterans poststroke, and it showed that patient characteristics accounted for only 6.2% of the variation. VHA administrative region and disability severity accounted for equivalent amounts of the variation. Our findings suggest the need for improvements in the process for providing AT and/or provider education concerning device provision.     

Effect of Ankle-Foot Orthosis Alignment and Foot-Plate Length on the Gait of Adults With Poststroke Hemiplegia

Fatone S, Gard SA, Malas BS. Effect of ankle-foot orthosis alignment and foot-plate length on the gait of adults with poststroke hemiplegia.

Objective

To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.

Design

Repeated measures, quasi-experimental study.

Setting

Motion analysis laboratory.

Participants

Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.

Interventions

Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90° plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with ¾ length foot-plate-¾ AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.

Main Outcome Measures

Sagittal plane ankle and knee kinematics and kinetics.

Results

In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.

Conclusions

These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.     

Effects of resistance training on lower-extremity impairments in older people with hip fracture

Portegijs E, Kallinen M, Rantanen T, Heinonen A, Sihvonen S, Alen M, Kiviranta I, Sipilä S. Effects of resistance training on lower-extremity impairments in older people with hip fracture.

Objective

To study the effects of resistance training on muscle strength parameters, mobility, and balance.

Design

Randomized controlled trial.

Setting

Research laboratory and senior gym.

Participants

Population-based sample of eligible 60- to 85-year-old community-dwelling men and women 0.5 to 7.0 years after hip fracture. Forty-six people had no contraindications and were willing to participate in the exercise trial.

Intervention

Twelve-week intensive progressive strength-power training (n=24), aiming to reduce asymmetric deficit in leg muscle strength and power, or no intervention (n=22).

Main Outcome Measures

Isometric knee extension torque (KET) and leg extension power (LEP) measured in the weaker and stronger leg and the asymmetric deficit ([weak/sum both legs] × 100%), 10-m walking speed, dynamic balance test, and self-reported outdoor mobility.

Results

KET increased in both legs (P<.021), LEP tended to increase in the weaker leg (P=.071), and asymmetric LEP deficit decreased (P=.010) after training compared with the control group. LEP of the stronger leg, asymmetric KET deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training. The compliance to the training was over 90%, and few adverse events (n=4; mainly musculoskeletal) were likely to be caused by the training.

Conclusions

Intensive resistance training is feasible for people with a hip fracture and improved muscle strength and power. More intensive training especially for the weaker leg may be needed to obtain more marked effects on asymmetric deficit, mobility, and balance. Also, the timing and duration of training program should be considered. (ISRCTN identifier ISRCTN34271567.)     

Virtual Reality-Enhanced Partial Body Weight-Supported Treadmill Training Poststroke: Feasibility and Effectiveness in 6 Subjects

Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training poststroke: feasibility and effectiveness in 6 subjects.

Objective

To determine whether the use of a low-cost virtual reality (VR) system used in conjunction with partial body weight-supported treadmill training (BWSTT) was feasible and effective in improving the walking and balance abilities of patients poststroke.

Design

A before-after comparison of a single group with BWSTT intervention.

Setting

University research laboratory.

Participants

A convenience sample of 7 adults who were within 1 year poststroke and who had completed traditional rehabilitation but still exhibited gait deficits. Six participants completed the study.

Intervention

Twelve treatment sessions of BWSTT with VR. The VR system generated a virtual environment that showed on a television screen in front of the treadmill to give participants the sensation of walking down a city street. A head-mounted position sensor provided postural feedback.

Main Outcome Measures

Functional Gait Assessment (FGA) score, Berg Balance Scale (BBS) score, and overground walking speed.

Results

One subject dropped out of the study. All other participants made significant improvements in their ability to walk. FGA scores increased from mean of 13.8 to 18. BBS scores increased from mean of 43.8 to 48.8, although a ceiling effect was seen for this test. Overground walking speed increased from mean of .49m/s to .68m/s.

Conclusions

A low-cost VR system combined with BWSTT is feasible for improved gait and balance of patients poststroke.     

Effect of Baseline Spastic Hemiparesis on Recovery of Upper-Limb Function Following Botulinum Toxin Type A Injections and Postinjection Therapy

Chang C-L, Munin MC, Skidmore ER, Niyonkuru C, Huber LM, Weber DJ. Effect of baseline spastic hemiparesis on recovery of upper-limb function following botulinum toxin type A injections and postinjection therapy.

Objective

To determine whether baseline hand spastic hemiparesis assessed by the Chedoke-McMaster Assessment influences functional improvement after botulinum toxin type A (BTX-A) injections and postinjection therapy.

Design

Prospective cohort study.

Setting

Outpatient spasticity clinic.

Participants

Participants (N=14) with spastic hemiparesis divided into 2 groups: Chedoke-McMaster Assessment Hand-Higher Function (stage≥4, n=5) and Chedoke-McMaster Assessment Hand-Lower Function (stage=2 or 3, n=9).

Interventions

Upper-limb BTX-A injections followed by 6 weeks of postinjection therapy.

Main Outcome Measures

Primary outcomes were Motor Activity Log-28 and Motor Activity Log items. Secondary outcomes were Action Research Arm Test (ARAT), Motor Activity Log-Self-Report, and Modified Ashworth Scale (MAS). Measures were assessed at baseline (preinjection), 6 weeks, 9 weeks, and 12 weeks postinjection.

Results

Primary and secondary outcomes improved significantly over time in both groups. Although no significant differences in ARAT or MAS change scores were noted between groups, Chedoke-McMaster Assessment Hand-Higher Function group demonstrated greater change on Motor Activity Log-28 (P=.013) from baseline to 6 weeks and Motor Activity Log items (P=.006) from baseline to 12 weeks compared to Chedoke-McMaster Assessment Hand-Lower Function group.

Conclusions

BTX-A injections and postinjection therapy improved hand function and reduced spasticity for both Chedoke-McMaster Assessment Hand-Higher Function and Chedoke-McMaster Assessment Hand-Lower Function groups. Clinicians should expect to see larger gains for persons with less baseline impairment.     

Improvement of Gaze Control After Balance and Eye Movement Training in Patients With Progressive Supranuclear Palsy: A Quasi-Randomized Controlled Trial

Zampieri C, Di Fabio RP. Improvement of gaze control after balance and eye movement training in patients with progressive supranuclear palsy: a quasi-randomized controlled trial.

Objective

One of the main oculomotor findings in progressive supranuclear palsy (PSP) is the inability to saccade downward. In addition, people with PSP have difficulty suppressing fixation, which may contribute to vertical gaze palsy. The objective was to investigate the effectiveness of a rehabilitation intervention tailored to enhance suppression of fixation and gaze shift in participants with PSP.

Design

Controlled trial with a quasi-randomized design. Measures occurred at week 1 and 5. Researchers assessing participants were blind to the group assignments.

Setting

Movement disorders assessment laboratory.

Participants

Nineteen adults with possible or probable PSP who were ambulatory for short distances and had far visual acuity of 20/80 and a Folstein Mini-Mental State score of more than 23.

Interventions

Balance training complemented with eye movement and visual awareness exercises was compared with balance training alone.

Main Outcome Measures

Gaze control was assessed using a vertical Gaze Fixation Score and a Gaze Error Index.

Results

Gaze control after the balance plus eye exercise significantly improved, whereas no significant improvement was observed for the group that received balance training alone.

Conclusions

These preliminary findings support the use of balance and eye movement exercises to improve gaze control in PSP.