Retraining selective trunk muscle activity: A key to more successful rehabilitation outcomes for hemiparetic stroke patients.

BACKGROUND: Hemiparetic patients lose the ability to move their trunk selectively, abdominals are affected and neither voluntary nor reflex activity is present. OBJECTIVE: To investigate if the inclusion of specific exercises for the trunk muscles in a rehabilitation program for chronic hemiparetic patients could lead to an additional improvement. METHODS: A multiple-participant single-subject design was replicated in patients with hemiplegia. The study was conducted in two cycles: for the first cycle (A), patients received conventional rehabilitation program, then for the second cycle (B), six months later, the same subjects received conventional rehabilitation therapy plus an additional specific selective trunk muscles training. Trunk Impairment Scale (TIS), Berg Balance Scale (BBS), 10 meters distance walk test (10 MWT), Functional Independence Measure (FIM) and instrumental gait analysis were performed before and after both treatment cycles. RESULTS: Significant changes were observed in TIS and 10 MWT after the two treatment cycles. However, after treatment cycle B, BBS and FIM score showed an additional improvement. Whereas, after treatment cycle A gait analysis did not relevantly changed, but after cycle B a significant improvement was registered in velocity, cadence and percentage of stance in the gait cycle. CONCLUSIONS: In our patients, the training for selective activation of the trunk muscles had led to a consistent improvement of gait analysis parameters, and hemiparesis-related disability in stance and activities of daily living.

"Masters and servants" in parkinsonian gait: a three-dimensional analysis of biomechanical changes sensitive to disease progression.

Gait disorder is a very frequent and disabling symptom in Parkinson's disease (PD). The aim of this study was to identify the main kinetic and kinematic features of PD gait according to different disease stages: early (Early Group), intermediate without freezing (Non-Freezers) and intermediate with freezing (Freezers). Kinematic data showed a distal to proximal progression of impairment from the early to the intermediate with freezing stage. The Early Group showed more accentuated ankle dorsiflexion during stance than the other PD subgroups; the Freezers showed a more flexed hip position at initial contact and a reduced range of motion (ROM) during stance compared with the other patients. The individuals in the intermediate stage (with or without freezing) displayed limited knee ROM. Distal to proximal progression of lower limb impairment in PD might be an expression of a rostral to caudal degeneration of locomotor control centers. Evaluation of the relationship between gait features "Masters and servants" in parkinsonian gait: a three-dimensional analysis of biomechanical changes sensitive to disease progression and disease progression may promote the development of tailored rehabilitation programs.

Gait pattern in myotonic dystrophy (Steinert disease): a kinematic, kinetic and EMG evaluation using 3D gait analysis.

We investigated the gait pattern of 10 patients with myotonic dystrophy (Steinert disease; 4 females, 6 males; age: 41.5+7.6 years), compared to 20 healthy controls, through manual muscle test and gait analysis, in terms of kinematic, kinetic and EMG data. In most of patients (80%) distal muscle groups were weaker than proximal ones. Weakness at lower limbs was in general moderate to severe and MRC values evidenced a significant correlation between tibialis anterior and gastrocnemius medialis (R=0.91). An overall observation of gait pattern in patients when compared to controls showed that most spatio-temporal parameters (velocity, step length and cadence) were significantly different. As concerns kinematics, patients' pelvic tilt was globally in a higher position than control group, with reduced hip extension ability in stance phase and limited range of motion; 60% of the limbs revealed knee hyperextension during midstance and ankle joints showed a quite physiological position at initial contact and higher dorsiflexion during stance phase if compared to healthy individuals. Kinetic plots evidenced higher hip power during loading response and lower ankle power generation in terminal stance. The main EMG abnormalities were seen in tibialis anterior and gastrocnemius medialis muscles. In this study gait analysis gives objective and quantitative information about the gait pattern and the deviations due to the muscular situation of these patients; these results are important from a clinical point of view and suggest that rehabilitation programs for them should take these findings into account.

Walking in an immersive virtual reality.

The aim of this study was to investigate the effects on gait induced by a completely immersive Virtual Reality (VR) with and without perturbation. Ten healthy subjects were analyzed during over-ground walking in different conditions: standard gait, VR gait and perturbed VR gait. Results showed that subjects immersed in the virtual environment walked slowly, with decreased cadence (-13%) and stride length (-28%) as well as increased base of support in terms of step width (+20%). The perturbation of the VR caused an interesting effect: many computed parameters, still away from the standard gait condition, improved if compared to the unperturbed VR condition. In conclusion, walking in VR leads to gait instability, which is less pronounced in presence of perturbation, probably due to the reweight of sensory inputs. This study could represent the first step for the application of the proposed VR environment to pathological subjects.

Behaviour of motor disabilities and appearance of visual hallucinations in patients with Parkinson's disease in a virtual environment.

We studied 23 Parkinson's disease (PD) non-demented patients and 15 controls in Virtual Reality (VR) environments reproducing usual daily living situations. In VR sessions, PD patients performed their actions worse than controls, in terms of time of execution in exploration and pointing, precision as objects avoiding, and in semantic incidental memory task. We observed clear differences of performances between on and off status medication, with a global worsening during off phase. Moreover, all six patients with motor fluctuations described visual hallucinations during off state, with occurrence of images not included in the virtual environment.

Virtual reality for the upper limb motor training in stroke: a case report.

In this report we describe the effects of a virtual reality (VR) training addressed to the upper limb of a stroke patient. After 20 days of rehabilitation sessions consisting of physical therapy and VR rehabilitation, the subject was evaluated by means of kinematics and clinical scales. Results showed the improvement of paretic arm mobility, in terms of quantitative parameters and clinical scales, suggesting that VR training could represent a valuable tool to supplement the traditional rehabilitation provided by the physical therapist.