Quantitative gait analysis in mild cognitive impairment, dementia, and cognitively intact individuals: a cross-sectional case-control study.

BACKGROUND: Cognitive age-related decline is linked to dementia development and gait has been proposed to measure the change in brain function. This study aimed to investigate if spatiotemporal gait variables could be used to differentiate between the three cognitive status groups. METHODS: Ninety-three older adults were screened and classified into three groups; mild cognitive impairment (MCI) (n = 32), dementia (n = 31), and a cognitively intact (n = 30). Spatiotemporal gait variables were assessed under single- and dual-tasks using an objective platform system. Effects of cognitive status and walking task were analyzed using a two-way ANCOVA. Sub-comparisons for between- and within-group were performed by one-way ANCOVA and Paired t-tests. Area Under the Curve (AUC) of Receiver Operating Characteristics (ROC) was used to discriminate between three groups on gait variables. RESULTS: There were significant effects (P < 0.05) of cognitive status during both single and dual-task walking in several variables between the MCI and dementia and between dementia and cognitively intact groups, while no difference was seen between the MCI and cognitively intact groups. A large differentiation effect between the groups was found for step length, stride length, and gait speed during both conditions of walking. CONCLUSIONS: Spatiotemporal gait variables showed discriminative ability between dementia and cognitively intact groups in both single and dual-tasks. This suggests that gait could potentially be used as a clinical differentiation marker for individuals with cognitive problems.

Five-Session Dual-Transcranial Direct Current Stimulation With Task-Specific Training Does Not Improve Gait and Lower Limb Performance Over Training Alone in Subacute Stroke: A Pilot Randomized Controlled Trial.

OBJECTIVE: To determine the effect of five-session dual-transcranial direct current stimulation (dual-tDCS) combined with task-specific training on gait and lower limb motor performance in individuals with subacute stroke. MATERIALS AND METHODS: Twenty-five participants who had a stroke in the subacute phase with mild motor impairment were recruited, randomized, and allocated into two groups. The active group (n = 13) received dual-tDCS with anodal over the lesioned hemisphere M1 and cathodal over the nonlesioned hemisphere, at 2 mA for 20 min before training for five consecutive days, while the sham group (n = 12) received sham mode before training. Gait speed as a primary outcome, temporospatial gait variables, lower-limb functional tasks (sit-to-stand and walking mobility), and muscle strength as secondary outcomes were collected at preintervention and postintervention (day 5), one-week follow-up, and one-month follow-up. RESULTS: The primary outcome and most of the secondary outcomes were improved in both groups, with no significant difference between the two groups, and most of the results indicated small to moderate effect sizes of active tDCS compared to sham tDCS. CONCLUSION: The combined intervention showed no benefit over training alone in improving gait variables and lower-limb performance. However, some performances were saturated at some point, as moderate to high function participants were recruited in the present study. Future studies should consider recruiting participants with more varied motor impairment levels and may need to determine the optimal stimulation protocols and parameters to improve gait and lower-limb performance.

Responsiveness of pain, functional capacity tests, and disability level in individuals with chronic nonspecific low back pain.

BACKGROUND: Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP). OBJECTIVE: This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP. METHODS: Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM). RESULTS: The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES -0.986, SRM -0.928) and five-time sit-to-stand test (5 TSST) (SRM -0.846). CONCLUSION: This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.

Effect of spinal tap test on the performance of sit-to-stand, walking, and turning in patients with idiopathic normal pressure hydrocephalus.

The aim of the study was to investigate the effect of the spinal tap test on sit-to-stand (STS), walking, and turning and to determine the relationship among the outcome measures of STS, walking, and turning in patients with iNPH. Twenty-seven patients with clinical symptoms of iNPH were objectively examined for STS, walking, and turning by the Force Distribution Measurement (FDM) platform connected with a video camera. Assessments were performed at before and 24 hours after spinal tap. Motor abilities were assessed by the STS time, time of walking over 3 meters, and time and number of steps when turning over 180 degrees. Significant improvements were found in the STS time (p = 0.046), walking time (p = 0.048), and turning step (p = 0.001). In addition, turning time was improved but not statistically significant (p = 0.064). Significant relationships were found among all outcome measures (p < 0.001). The relationship among these outcome measures indicated that the individuals had similar ability levels to perform different activities. This may serve as a new choice of outcome measures to evaluate the effect of intervention in different severity levels of patients with iNPH.

Ground Reaction Forces of the Lead and Trail Limbs when Stepping Over an Obstacle.

BACKGROUND: Precise force generation and absorption during stepping over different obstacles need to be quantified for task accomplishment. This study aimed to quantify how the lead limb (LL) and trail limb (TL) generate and absorb forces while stepping over obstacle of various heights. MATERIAL AND METHODS: Thirteen healthy young women participated in the study. Force data were collected from 2 force plates when participants stepped over obstacles. Two limbs (right LL and left TL) and 4 conditions of stepping (no obstacle, stepping over 5 cm, 20 cm, and 30 cm obstacle heights) were tested for main effect and interaction effect by 2-way ANOVA. Paired t-test and 1-way repeated-measure ANOVA were used to compare differences of variables between limbs and among stepping conditions, respectively. The main effects on the limb were found in first peak vertical force, minimum vertical force, propulsive peak force, and propulsive impulse. RESULTS: Significant main effects of condition were found in time to minimum force, time to the second peak force, time to propulsive peak force, first peak vertical force, braking peak force, propulsive peak force, vertical impulse, braking impulse, and propulsive impulse. Interaction effects of limb and condition were found in first peak vertical force, propulsive peak force, braking impulse, and propulsive impulse. CONCLUSIONS: Adaptations of force generation in the LL and TL were found to involve adaptability to altered external environment during stepping in healthy young adults.

Effects of Foot Muscles Training on Plantar Pressure Distribution during Gait, Foot Muscle Strength, and Foot Function in Persons with Flexible Flatfoot.

OBJECTIVE: To investigate the effects of a foot-muscle trainingprogram on plantarpressure distribution, foot muscle strength, and foot function in persons with flexible flatfoot. MATERIAL AND METHOD: Participants received foot-muscle training 3 times weekly, over 8 weeks. Training consisted of gastrosolues muscle stretching and strengthening the muscles around the ankle and the intrinsic muscles. The contact area andpeak pressure under the hallux, first metatarsal, and medial midfoot were assessed by the Force Distribution Measurement Plaform while walking. Strength ofthe tibialis posterior and peroneus longus muscles were assessed by handheld dynamometer. Foot function regarding difficulty in activities of daily living was assessed. All measures were assessed at pre-training, intermediate-training, and post-training. Friedman ANOVA was used for testing mean differences among the variables. RESULTS: Five participants with flexible flatfoot were recruited in the study. Results demonstrated significant increases in tibialis posterior (p = 0.018) and peroneus longus muscles strength (p = 0.007), and significant decrease infootfunction score (p = 0.021). In addition, no significant difference in contact area and peak pressure was observed among testing periods. CONCLUSION: Foot-muscle strength and foot function in persons with flexible flatfoot can be improved significantly after receiving foot-muscle training.

Gluteus Medius Muscle Activities during Standing Hip Abduction Exercises in the Transverse Plane at Different Angles.

OBJECTIVE: To examine gluteus medius (GMed) muscle activity while performing standing hip abduction exercise in the transverse plane at different angles. MATERIAL AND METHOD: Muscle activity of both sides of the GMed was measured by electromyography (EMG) with a sampling frequency of 1,500 Hz. Participants were asked to perform standing hip abduction exercise in the transverse plane at different angles including 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees, 75 degrees, and 90 degr Percent maximum voluntary isometric contraction (MVIC) of average EMG of GMed muscles was reportedfrom three trials for each limb. Repeated-measure ANOVA was used to analyze the data. RESULTS: Nine healthy volunteers were included in the present study. The finding indicated that angle of hip motion in the transverse plane significantly (p<0.05) affects GMed muscle activity of swing and stance limbs. Standing hip abduction exercise at 30 degrees in the transverse plane was observed to produce the highest EMG ofswing limb (64.68% MVIC) than other angles. In stance limb, a decreasing trend of GMed muscle activity while performing standing hip abduction exercise was noted from 0 degree to 90 degres in the transverse plane, respectively. CONCLUSION: GMed muscle activities ofswing and stance limbs during hip abduction exercise exhibited the highest EMG at 30 degrees and 0 degrees in the transverse plane, respectively. Therefore, these exercises of GMed muscle could be suggested for early rehabilitation. Standing exercises with 0 degrees and 30 degrees hip abductions might be suitable for weight bearing and non-weight bearing purposes.

Correlation between Pressure Pain Threshold and Soft Tissue Displacement in Muscle Pain Conditions.

OBJECTIVE: To determine the correlation between pressure pain threshold (PPT), displacement pain threshold (DI) and pain visual analog scale (VAS) in patients with delayed onset muscle soreness (DOMS) and myofascial pain syndrome (MPS). MATERIAL AND METHOD: PPT and DPT were measured in the same time by modified Algometer commander. This study used the algometer for measuring PPT (N/cm2), in three groups of subjects, including DOMS (n=10), MPS (n=10), and asymptomatic (n=10). The DPT represented the displacement of the algometer probe on the skin in millimeters, while measuring PPT The DOMS was induced in the non-dominant biceps brachii muscle. The subjects with active myofascial trigger point (MTrP) at the upper trapezius muscle were recruited into the MPS group. DOMS group rated pain by VAS during elbow movement, while the MPS group rated at resting. Spearman's rank coefficient of correlation was usedfor data analysis. RESULTS: The results showed correlation between PPT and DPT in the asymptomatic biceps brachii muscle (r = 0.77, p = 0.001) andDOMS group (r(s) = 0.65, p = 0.04). No correlation wasfound between MPS and the asymptomatic upper trapezius muscle. CONCLUSION: A correlation was found between PPTandDPT in biceps brachii muscles. Thisfinding suggested that to assess the DOMS, the PPT and DPT accurately are requiredfor identifying pain and tissue softness.

Plantar Pressure Distribution Pattern during Mid-Stance Phase of the Gait in Patients with Chronic Non-Specific Low Back Pain.

OBJECTIVE: To examine the characteristics of the plantar pressure distribution patterns during mid-stance phase of the gait cycle in subjects with chronic non-specific low back pain and asymptomatic subjects. MATERIAL AND METHOD: Twenty-three males and 17 females with chronic non-specific low back pain and age- and gender-matched asymptomatic subjects walked barefoot along a gait mat at comfortable speedfor three trials. The left and right plantar pressure distributions were recorded during mid-stance phase and divided into 12 areas. Descriptive statistics including mean and standard deviation of demographic data and plantar pressure were calculated, and plantar pressure distribution patterns were described. RESULTS: Mean and standard deviation of numeric pain rating scale of chronic non-specific low back pain group were 4.04±1.58. The average mean peak pressure of both chronic non-specific low back pain and asymptomatic subjects located at the fifth area (lateral aspect offorefoot) in both feet. However the modes of the peak pressure of subjects with chronic non-specific low back pain were in the different areas in the left and right feet. The distribution patterns of the average mean peak pressure were not the same in chronic non-specific low back pain and asymptomatic subjects. This altered foot contact in the subjects with chronic non-specific low back pain may be used to avoid pain or to compensate for limited mobility of the lower limbs at pre-swing phase. CONCLUSION: At mid-stance phase of walking, the pressures on the plantar surface were unequally distributed in subjects with chronic non-specific low back pain.

Cross-Cultural Adaptation of the Compendium of Physical Activity: Thai Translation and Content Validity.

OBJECTIVE: To translate the compendium physical activity (compendium) proposed by Ainsworth to Thai and to validate the Thai translated version. MATERIAL AND METHOD: Five steps of cross-cultural adaption were conducted as follows: (1) forward translation, (2) group review, (3) backward translation, (4) group review and final decision and (5) a pilot study. Eight hundred and twenty-one activities ofthe compendium were translated to Thai by two independents translators. Thai translated version was considered by 23 persons who have studied physical activity for at leastfive years. Backward translation was carried out by two bilingual translators. The research team completed the final Thai translation by comparing original and translated versions. For pilot study the Thai translated version was validated by 22 allied health persons. Data was analyzed by multi-rater agreement (Fleiss's kappa) and qualitative analysis. RESULTS: For translations and group review, recommendations included; (a) changing to lay language with the same meaning, (b) converting the U.S. customary unit to the metric unit, and (c) using consistent language. More than 80% of 22 persons accepted the Thai translation and the Kappa agreement rangedfrom 0.187 to 0.694. Some activities demonstratedpoor multi-rater agreement and required additional definitions. CONCLUSION: Thai translated compendium physical activity was constructed to reduce the language barrier and promote physical activity in Thailand. The poor to moderate agreement of each major heading of translation may partly be due to Western culture. Many activities in the compendium were assembled but they were not recognized by Thais. Hence, Thai compendium physical activity should to be developed in afuture study.

Reach-to-grasp co-ordination in the paretic limbs of individuals with stroke: insight from a barrier paradigm.

OBJECTIVE: Reach and grasp components must be co-ordinated to preserve the optimal reach-to-grasp performance. However conflicting results regarding the deficit in reach-to-grasp co-ordination has been reported in the paretic hand of individuals after stroke. Additionally, investigations have not been undertaken to study more challenging task constraints to induce the impairment of reach-to-grasp co-ordination. This study aimed to compare reach-to-grasp co-ordination while avoiding an obstacle in the paretic hand of individuals after stroke with matched non-disabled adults. MATERIAL AND METHOD: Twenty-four participants having mild severity of upper extremity impairment were recruited with an equal number of non-disabled adults. Kinematic reach-to-grasp movements with obstacle avoidance were analyzed. Reach-to-grasp co-ordination was quantified using cross-correlation analysis: maximum correlation coefficient represented the spatial aspect and the time lag represented the temporal aspects. RESULTS: Individuals after stroke showed a significant disturbance in the temporal aspect of reach-to-grasp co-ordination, but not the spatial aspect as compared with non-disabled adults. CONCLUSION: Among participants, after stroke reach-to-grasp co-ordination was delayed in the temporal aspect of reach-to-grasp with obstacle avoidance but preserved in the spatial aspect. Specific methods to assess reach-to-grasp co-ordination and to treat the time delay to improve co-ordination should be considered in individuals after stroke.

Immediate effects of trunk stabilizer muscles training on muscle response time in individuals with non-specific chronic low back pain.

OBJECTIVE: To investigate immediate effects of biofeedback training on motor control performance in participants with nonspecific chronic low back pain. MATERIAL AND METHOD: RCT was conducted. The training group received isolated and co-contraction training of trunk stabilizers in lying on the left side, sitting on stool and sitting on a gymnastic ball, while the control group was asked to rest comfortably on a chair. Trunk muscles response time during rapid arm movement test was recorded using surface electromyography. Two-way ANOVA and Bonferroni post hoc test were used to detect changes within and between groups. RESULTS: In the training group, the trunk muscles response times were significantly decreased after training when compared with those in the control group (p<0.05). CONCLUSION: Trunk stabilizer training has a beneficial effect on motor response time of the trunk muscles. The long-term effects of exercise should be further considered with a larger sample size.

Residual deficits of knee and hip joint coordination and clinical performance after return to sports in athletes with anterior cruciate ligament reconstruction.

BACKGROUND: Biomechanical changes and neuromuscular adaptations have been suggested as risk factors of secondary injury in individuals after anterior cruciate ligament reconstruction (ACLr). To achieve a better understanding of preventive mechanisms, movement quality is an important factor of consideration. Few studies have explored time-series analysis during landing alongside clinical performance in injured and non-injured individuals. The purpose of the study was to investigate the biomechanical risks of recurrent injury by comparing clinical and jump-landing performance assessments between athletes with ACLr and healthy controls. METHOD: This study was observational study. Sixteen athletes with and without ACLr voluntarily participated in clinical and laboratory measurements. Single-leg hop distance, isokinetic tests, landing error score, and limb symmetry index (LSI) were included in clinical report. Lower limb movements were recorded to measure joint biomechanics during multi-directional landings in motion analysis laboratory. Hip-knee angle and angular velocity were explored using discrete time-point analysis, and a two-way mixed analysis of variance (2 × 4, group × jump-landing direction) was used for statistical analysis. Time series and hip-knee coordination analyses were performed using statistical parametric mapping and descriptive techniques. RESULTS: Significantly lower single-leg hop distance was noted in ACLr group (158.10 cm) compared to control group (178.38 cm). Although the hip and knee moments showed significant differences between four directions (p < 0.01), no group effect was observed (p > 0.05). Statistical parametric mapping showed significant differences (p ≤ 0.05) between groups for hip abduction and coordinate plot of hip and knee joints. Athletes with ACLr demonstrated a higher velocity of hip adduction. Time-series analysis revealed differences in coordination between groups for frontal hip and knee motion. CONCLUSIONS: Athletes with ACLr landed with poor hip adduction control and stiffer knee on the involved side. Multi-directions landing should be considered over the entire time series, which may facilitate improved movement quality and return to sports in athletes with ACLr.

Clinical improvements in temporospatial gait variables after a spinal tap test in individuals with idiopathic normal pressure hydrocephalus.

Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological condition that often presents gait disturbance in the early stages of the disease and affects other motor activities. This study investigated changes in temporospatial gait variables after cerebrospinal fluid (CSF) removal using a spinal tap test in individuals with idiopathic normal pressure hydrocephalus (iNPH), and explored if the tap test responders and non-responders could be clinically identified from temporospatial gait variables. Sixty-two individuals with iNPH were recruited from an outpatient clinic, eleven were excluded, leaving a total of 51 who were included in the analysis. Temporospatial gait variables at self-selected speed were recorded at pre- and 24-h post-tap tests which were compared using Paired t-tests, Cohen's d effect size, and percentage change. A previously defined minimal clinical important change (MCIC) for gait speed was used to determine the changes and to classify tap test responders and non-responders. A mixed model ANOVA was used to determine the within-group, between-group, and interaction effects. Comparisons of the data between pre- and post-tap tests showed significant improvements with small to medium effect sizes for left step length, right step time, stride length and time, cadence, and gait speed. Gait speed showed the largest percentage change among temporospatial gait variables. Within-group and interaction effects were found in some variables but no between-group effect was found. Tap test responders showed significant improvements in right step length and time, stride length and time, cadence, and gait speed while non-responders did not. Some individuals with iNPH showed clinically important improvements in temporospatial gait variables after the tap test, particularly in step/stride length and time, cadence, who could be classified by gait speed. However, gait-related balance variables did not change. Therefore, additional treatments should focus on improving such variables.

Feasibility investigation of the Accelerated Skill Acquisition Program (ASAP): insights into reach-to-grasp coordination of individuals with postacute stroke.

BACKGROUND: Skill acquisition, capacity building, and motivational enhancements are the basis of the Accelerated Skill Acquisition Program (ASAP) and form the foundation for effective incorporation of the paretic upper extremity into life activities. This is the first phase I trial to deliver ASAP during the postacute interval in mildly to moderately impaired stroke survivors and to include an assessment of paretic reach-to-grasp (RTG) coordination using RTG task and cross-correlation analyses. METHODS: Two baseline and posttreatment evaluations consisted of RTG actions, the Wolf Motor Function Test (WMFT), and the Stroke Impact Scale (SIS). An individualized arm therapy program using ASAP principles was administered for a total of 30 hours, 2 hours per day, for 2 to 4 days per week over 5 weeks. Dependent measures were kinematics of RTG actions, RTG coordination, total time score of WMFT, and stroke recovery score of SIS. RESULTS: All participants tolerated ASAP well, and none reported any adverse effects during or after the protocol. When the 2 baseline evaluations were compared, there were no changes in any RTG kinematics or RTG coordination. In contrast, after 30 hours of ASAP, total movement time and deceleration time of RTG actions markedly decreased, maximum reach (transport) velocity strikingly increased, and time of maximum aperture was accomplished later. Additionally, the maximal RTG correlation coefficient increased with a shorter associated time lag. A similar pattern was observed for the clinical outcome measures of WMFT and SIS. CONCLUSIONS: The findings demonstrate the feasibility of using an ASAP protocol for patients 1 to 3 months post stroke. Under ASAP, WMFT tasks and RTG actions were performed faster with higher peak transport velocity and a more coordinated RTG pattern. The next step is to determine whether the immediate gains in the skilled RTG actions persist 6 months alter.

Impact on participation and autonomy questionnaire: psychometric properties of the thai version.

[Purpose] The present study aimed to cross-culturally translate and evaluate the reliability and validity of the Thai version of the Impact on Participation and Autonomy (IPA) in persons with spinal cord injury (SCI). [Subjects] One hundred and thirty-nine persons with SCI who lived in the community were recruited for this study. [Methods] The IPA was translated following the guideline for cross-cultural adaptation of self-report measures. The reliability and validity was examined in 139 persons with SCI. For the test-retest reliability, 30 participants completed the Thai version of the IPA twice with a 2-week interval. [Results] The translated questionnaire and its items had moderate to good reliability, with the ICC(3,1) ranging from 0.76 to 0.93. The internal consistency for all domains was high, with Cronbach's alpha ranging from 0.86 to 0.90. The convergent validity, discriminant validity, and construct validity were supported. [Conclusion] The Thai version of the IPA is a reliable and valid instrument for assessing the level of community participation in Thai persons with spinal cord injury.

Different Sagittal Angles and Moments of Lower Extremity Joints during Single-leg Jump Landing among Various Directions in Basketball and Volleyball Athletes.

[Purpose] The purpose of this study was to assess the sagittal angles and moments of lower extremity joints during single-leg jump landing in various directions. [Subjects] Eighteen male athletes participated in the study. [Methods] Participants were asked to perform single-leg jump-landing tests in four directions. Angles and net joint moments of lower extremity joints in the sagittal plane were investigated during jump-landing tests from a 30-cm-high platform with a Vicon™ motion system. The data were analyzed with one-way repeated measures ANOVA. [Results] The results showed that knee joint flexion increased and hip joint flexion decreased at foot contact. In peak angle during landing, increasing ankle dorsiflexion and decreasing hip flexion were noted. In addition, an increase in ankle plantarflexor moment occurred. [Conclusion] Adjusting the dorsiflexion angle and plantarflexor moment during landing might be the dominant strategy of athletes responding to different directions of jump landing. Decreasing hip flexion during landing is associated with a stiff landing. Sport clinicians and athletes should focus on increasing knee and hip flexion angles, a soft landing technique, in diagonal and lateral directions to reduce risk of injury.

Effects of strength and endurance training of superficial and deep neck muscles on muscle activities and pain levels of females with chronic neck pain.

[Purpose] To compare muscle activities and pain levels of females with chronic neck pain receiving different exercise programs. [Subjects and Methods] One hundred females with chronic neck pain participated in this study. They were randomly allocated into 4 groups (n = 25) on the basis of the exercises performed as follows: strength-endurance exercise, craniocervical flexion exercise, combination of strength-endurance and craniocervical flexion exercise and control groups. Pain, disability levels and changes in the muscle activities of the cervical erector spinae (CE), sternocleidomastoid (SCM), anterior scalenes (AS) and upper trapezius (UT) muscles were evaluated before and after the interventions. [Results] After 12 weeks of exercise intervention, all three exercise groups showed improvements in pain and disability. The muscle activities during the typing task were significantly different from the control group in all three exercise groups for all muscles except those of the extensor muscles in the craniocervical flexion exercise group. [Conclusion] The results of this study indicate that exercises for the cervical muscles improve pain and disability. The exercise programs reduced the activities of almost all cervical muscles.

Effects of home-based dual-hemispheric transcranial direct current stimulation combined with exercise on upper and lower limb motor performance in patients with chronic stroke.

PURPOSE: This study aimed to determine the effects of home-based dual-hemispheric transcranial direct current stimulation (dual-tDCS) combined with exercise on motor performance in patients with chronic stroke. MATERIALS AND METHODS: We allocated 24 participants to the active or sham group. They completed 1-h home-based exercise after 20-min dual-tDCS at 2-mA, thrice a week for 4 weeks. The patients were assessed using the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test, Timed Up and Go test, Five Times Sit-to-Stand Test, Six-meter Walk Test, and muscle strength assessment. RESULTS: Compared with the sham group, the active group showed improved FMA scores, which were sustained for at least 1 month. There was no between-group difference in the outcomes of the functional tasks. CONCLUSION: Home-based dual-tDCS could facilitate motor recovery in patients with chronic stroke with its effect lasting for at least 1 month. However, its effects on functional tasks remain unclear. tDCS is safe and easy for home-based self-administration for patients who can use their paretic arms. This could benefit patients without access to health care centres or in situations requiring physical distancing. This home-based tDCS combined with exercise has the potential to be incorporated into telemedicine in stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONTwelve sessions of home-based dual-tDCS combined with exercises (3 days/week for 4 weeks) facilitated upper and lower limb motor recovery in patients with chronic stroke compared with exercise alone, with a post-effect for at least 1 month.Home-based tDCS could be safe and easily self-administrable by patients who can use their paretic arms.This intervention could be beneficial for patients living in the community without easy access to a health care centre or in situations where physical distancing is required.

Concurrent Validity and Reliability of Two-dimensional Frontal Plane Knee Measurements during Multi-directional Cutting Maneuvers.

BACKGROUND: Excessive knee valgus has been strongly suggested as a contributing key factor for anterior cruciate ligament (ACL) injuries. Three-dimensional (3D) motion analysis is considered the "gold standard" to assess joint kinematics, however, this is difficult for on-field assessments and for clinical setting. PURPOSE: To investigate the concurrent validity of 2D measurements of knee valgus angle during cutting in different directions and to explore intra-rater and inter-rater reliability of the 2D measurements. STUDY DESIGN: Descriptive laboratory study. METHOD: Seven recreational soccer players participated in this study. Participants performed three trials of cutting maneuvers in three different directions (30º, 60º, and 90º) with the dominant leg. Cutting maneuvers were recorded simultaneously with a video camera and a ViconTM motion capture system. Knee valgus angle from 2D and 3D measurements at initial contact and at peak vertical ground reaction force (vGRF) were extracted. The Pearson's correlation was used to explore the relationship between the 2D and 3D measurements, and reliability of the 2D measurements were performed using intraclass correlation coefficients (ICC). RESULT: Significant correlations between 2D and 3D knee valgus measurements were noted for 60º (r = 0.45) and 90º (r = 0.77) cutting maneuvers at initial contact. At peak vGRF, significant correlations between 2D and 3D knee valgus measurements were noted for 30º, 60º, and 90º cutting maneuvers (r=0.45, r=0.74, r=0.78), respectively. Good-to-excellent intra-rater and inter-rater reliability of the 2D knee valgus measurements was observed during cutting in all directions (ICCs: 0.821-0.997). CONCLUSION: Moderate-to-strong correlation between 2D and 3D knee valgus measurements during 60°-90° cutting maneuvers, and good-to-excellent intra-rater and excellent inter-rater reliability for the 2D measurements in the present study supports the use of 2D knee valgus measurements in the evaluation of targeted interventions, although the limitations of examining cutting maneuvers using 2D measurement in complex movement still need to be considered. LEVEL OF EVIDENCE: 3.