Spasticity Predicts Motor Recovery for Patients with Subacute Motor Complete Spinal Cord Injury.

OBJECTIVE: A motor complete spinal cord injury (SCI) results in the loss of voluntary motor control below the point of injury. Some of these patients can regain partial motor function through inpatient rehabilitation; however, there is currently no biomarker to easily identify which patients have this potential. Evidence indicates that spasticity could be that marker. Patients with motor complete SCI who exhibit spasticity show preservation of descending motor pathways, the pathways necessary for motor signals to be carried from the brain to the target muscle. We hypothesized that the presence of spasticity predicts motor recovery after subacute motor complete SCI. METHODS: Spasticity (Modified Ashworth Scale and pendulum test) and descending connectivity (motor evoked potentials) were tested in the rectus femoris muscle in patients with subacute motor complete (n = 36) and motor incomplete (n = 30) SCI. Motor recovery was assessed by using the International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS). All measurements were taken at admission and discharge from inpatient rehabilitation. RESULTS: We found that motor complete SCI patients with spasticity improved in motor scores and showed AIS conversion to either motor or sensory incomplete. Conversely, patients without spasticity showed no changes in motor scores and AIS conversion. In incomplete SCI patients, motor scores improved and AIS conversion occurred regardless of spasticity. INTERPRETATION: These findings suggest that spasticity represents an easy-to-use clinical outcome that might help to predict motor recovery after severe SCI. This knowledge can improve inpatient rehabilitation effectiveness for motor complete SCI patients. ANN NEUROL 2023.

Toward a Smart Sensing System to Monitor Small Animal's Physical State via Multi-Frequency Resonator Array.

This article presents a highly scalable and rack-mountable wireless sensing system for long-term monitoring (i.e., sense and estimate) of small animal/s' physical state (SAPS), such as changes in location and posture within standard cages. The conventional tracking systems may lack one or more features such as scalability, cost efficiency, rack-mount ability, and light condition insensitivity to work 24/7 on a large scale. The proposed sensing mechanism relies on relative changes of multiple resonance frequencies due to the animal's presence over the sensor unit. The sensor unit can track SAPS changes based on changes in electrical properties in the sensors near fields, appearing in the resonance frequencies, i.e., an Electromagnetic (EM) Signature, within the 200 MHz-300 MHz frequency range. The sensing unit is located underneath a standard mouse cage and consists of thin layers of a reading coil and six resonators tuned at six distinct frequencies. ANSYS HFSS software is used to model and optimize the proposed sensor unit and calculate the Specific Absorption Rate (SAR) obtained under 0.05 W/kg. Multiple prototypes have been implemented to test, validate, and characterize the performance of the design by conducting in vitro and in vivo experiments on Mice. The in-vitro test results have shown a 15 mm spatial resolution in detecting the mouse's location over the sensor array having maximum frequency shifts of 832 kHz and posture detection with under 30° resolution. The in-vivo experiment on mouse displacement resulted in frequency shifts of up to 790 kHz, indicating the SAPS's capability to detect the Mice's physical state.

Camera-Based Short Physical Performance Battery and Timed Up and Go Assessment for Older Adults With Cancer.

This paper presents an automatic camera-based device to monitor and evaluate the gait speed, standing balance, and 5 times sit-stand (5TSS) tests of the Short Physical Performance Battery (SPPB) and the Timed Up and Go (TUG) test. The proposed design measures and calculates the parameters of the SPPB tests automatically. The SPPB data can be used for physical performance assessment of older patients under cancer treatment. This stand-alone device has a Raspberry Pi (RPi) computer, three cameras, and two DC motors. The left and right cameras are used for gait speed tests. The center camera is used for standing balance, 5TSS, and TUG tests and for angle positioning of the camera platform toward the subject using DC motors by turning the camera left/right and tilting it up/down. The key algorithm for operating the proposed system is developed using Channel and Spatial Reliability Tracking in the cv2 module in Python. Graphical User Interfaces (GUIs) in the RPi are developed to run tests and adjust cameras, controlled remotely via smartphone and its Wi-Fi hotspot. We have tested the implemented camera setup prototype and extracted all SPPB and TUG parameters by conducting several experiments on a human subject population of 8 volunteers (male and female, light and dark complexions) in 69 test runs. The measured data and calculated outputs of the system consist of tests of gait speed (0.041 to 1.92 m/s with average accuracy of >95%), and standing balance, 5TSS, TUG, all with average time accuracy of >97%.

The effects of Task-Oriented Motor Training on gait characteristics of patients with type 2 diabetes neuropathy.

BACKGROUND: It is known that general gait training improves lower extremity muscle strength and endurance in Diabetes Neuropathy (DN). But, it is still unknown whether Task-Oriented (TO) gait training would change gait biomechanics and the risk of falling in DN. TO gait training focuses on promoting timing and coordination of lower extremity movements through goal-directed practices with sufficient repetition. METHODS: A group of 14 patients with DN participated in a time-series study. All subjects participated in four sessions of assessments (Initial, Pre, Post and Follow-Up). Training was twice a week for 12 weeks. Vertical and horizontal Ground Reaction Forces (GRF), Time Get up and Go (TGUG) and Fall Efficacy Scale-International (FES-I) were evaluated. Gait training started with stepping patterns that progressively changed to complicated patterns of walking. Then, training continued combining walking patterns with upper extremity activities and then ended with treadmill-paced practice. RESULTS: DN patients significantly increased Second Vertical Peak Force and Horizontal Propulsive Force in addition decrease in Minimum Vertical Force. TGUG significantly decreased while FES-I reflected significant increase after gait training. DISCUSSION: Conclusively, training not only improved gait performance, confidence in daily activities and attenuated risk of falling, but also helped DN patients to improve feet biomechanics, muscles timing and coordination. CONCLUSIONS: Gait training with respect to principles of motor learning allowed patients to effectively improve through sessions.

Spectral characteristics of postural sway in diabetic neuropathy patients participating in balance training.

BACKGROUND: The aim of the present study is to have a detailed frequency analysis about the effect of balance training with respect to reactive movement strategies and sensory strategies in type 2 diabetic neuropathy (DN) patients. Also understand changes in the role of each postural subsystem for controlling quiet standing after balance training. METHODS: A group of 19 patients were included in the quasi experimental, time- series study. Total frequency power, 99% power frequency, centroidal frequency and frequency spectrum in the intervals between 0.01-0.1, 0.1-0.5, 0.5-1 Hz and 1-3 Hz are reported. The training protocol consisted two patterns of limits of stability trainings, three approaches in weight shifting trainings and one stable standing practice on the biodex stability system. RESULTS: Repeated measure ANOVA analysis and the LSD test indicated significant differences for the eyes open ML- frequency power and ML-FFT sway power within low-medium (0.1-0.5 HZ) frequencies. CONCLUSIONS: Decrease in postural sway at low-medium frequencies showed lower reliance on vestibular system. Also, better controlling hip muscles after balance training relieve DN patients' requirement to more exploratory sway as a compensatory strategy and showed better balance performance after balance training in DN patients. TRIAL REGISTRATION: UMIN-CTR Search Clinical Trials: UMIN000004485.

Dynamic stability training improves standing balance control in neuropathic patients with type 2 diabetes.

Patients with type 2 diabetic neuropathy (DN) are at an increased risk of falls due to the decreased accurate proprioceptive feedbacks. Effective balance training should treat context-specific instabilities of postural control of patients with DN. For this purpose, evaluations and balance training were designed with a 3-week baseline with evaluation after 3 weeks, followed by training over 3 weeks with reevaluation. We acquired control scores for standing balance from the Biodex stability system and fluctuations of the center of pressure. We performed repeated measure analysis of variance to test mean differences in three sessions of assessments. In addition, we compared mean differences of each pair of sessions with the least significant difference test. We used the paired t-test to compare the pure effects of trainings. Our investigation showed that the results of Biodex stability scores and force platform medial-lateral sway measurements improved statistically. Significant higher open-eyes median and mean frequency values of postural sway in the medial-lateral direction indicated that balance training allowed patients to develop control over the degree of freedom at the hip joint. In conclusion, training that compensates for disordered balance indicated by subclinical constraints with respect to the guidance effect of external visual feedback improves standing postural control in patients with type 2 DN.

Effects of physiotherapeutic TENS in a woman with unexplained infertility.

Unexplained infertility (UI) is a difficult diagnosis in the field of obstetrics and gynaecology. This report describes TENS treatment as an adjunct therapy for a 30-year-old woman with long-standing UI who was scheduled to undergo ovarian stimulation for in vitro fertilization (IVF) and embryo transfer. She had three unsuccessful intrauterine insemination treatments. Her last IVF treatment also failed. The treatment consisted of burst-TENS for seven sessions, which was applied daily from the second day of induction of ovulation (IO) to hCG administration. The transvaginal ultrasonography with pulsed Doppler curves was performed to measure the uterine artery impedance indices of Pulsatility Index (PI) and Resistance Index (RI). Before TENS application, on the first day of IO, the PI and RI for right side uterine artery were 3.96 and 0.96, respectively. For left uterine artery, the PI and RI were 6.92 and 1, respectively. After treatment with TENS, on the day of hCG administration, the PI and RI for right side uterine artery were 3.39 and 0.90, respectively. On the left side, they were PI=2.62 and RI=0.86. IVF was performed and on the day of oocytes collection, 22 oocytes were collected and inseminated. Fertilization was confirmed 16 hours after insemination by visualization of 2 pronuclei. A singleton pregnancy was achieved by the presence of a fetal sac during an ultrasound examination. It is concluded that the addition of TENS resulted in remarkable reduction of uterine artery PI and RI and a successful pregnancy after IVF for this woman with UI.