Usability of the novel ankle training equipment with spring resistance-based plantar press exercises in the standing position: A focus on chronic stroke patients with hemiplegic gait.

BACKGROUND: To improve gait disability in patients with chronic stroke, ankle muscle strengthening and calf muscle stretching exercises are required. However, currently available ankle training equipment limit ankle exercises based on the position. Recently developed ankle training equipment enables spring resistance-based plantar press exercises to be performed in the standing position with weight support. OBJECTIVE: To conduct a usability test of the ankle training equipment in the standing position by stroke patients with hemiplegic gait and verify its effects on ankle movements. METHODS: The ankle training equipment was applied to five patients with chronic stroke and hemiplegic gait. In the standing position, the patients performed forefoot and rearfoot press exercises in the affected side with a day's interval at 20 repetitions maximum (RM). During the exercises, surface electromyography (sEMG) was used to measure the maximum voluntary isometric contraction (%MVIC) of the leg muscles. The System Usability Scale (SUS) was used to assess the ankle training equipment. Wilcoxon signed-rank test was used to evaluate the differences in muscle activity between the two exercises. RESULTS: Forefoot and rearfoot press exercises increased the %MVIC in the biceps femoris. Additionally, the tibialis anterior and medial gastrocnemius activity was significantly different between the two exercises. The SUS was 78.75% (SD 12.7). CONCLUSION: The usability test of the passive-control foot press trainer (PFPT) that with improvements in the structure and functions for convenience, it could be commercialized. PFPT could be an alternative to the ankle rehabilitation robot that necessitates a sitting position.

Incidence and Risk Factors of Opaque Bubble Layer Formation According to Flap Thickness During 500-kHz FS-LASIK.

PURPOSE: To present the incidence, risk factors, and effect of opaque bubble layer (OBL) formation during flap creation in laser-assisted in situ keratomileusis (LASIK) with a 500-kHz femtosecond laser on visual performance. METHODS: In this retrospective study, preoperative characteristics (age, sex, keratometric value, spherical equivalent, and central corneal thickness) and intraoperative surgical factors (used energy, docking type, and flap thickness) were compared between eyes with and without OBL formation during flap creation. Possible risk factors for specific types of OBLs were analyzed. RESULTS: One hundred thirty-five eyes of 71 patients underwent LASIK, and OBL developed in 98 eyes (72.59%). In the univariate analysis, the greater than 80-µm flap group was associated with a lower OBL occurrence than the 80-µm flap group (P = .0424, odds ratio [OR] = 0.481) and hard docking was associated with increased OBL formation (P = .0001, OR = 6.859). In the multivariate analysis, hard docking was a risk factor for OBL development (P = .0003, OR = 6.329). In the subgroup analysis, hard docking had a marginal effect on OBL occurrence in the 80-µm flap group (P = .086, OR = 3.564), but it had a strong effect in the greater than 80-µm flap group (P = .0018, OR = 10.210). CONCLUSIONS: Hard docking is a risk factor for OBL development. However, hard docking had a small effect on OBL occurrence in the 80-µm flap group during LASIK. OBL formation did not affect visual performance. [J Refract Surg. 2019;35(9):583-589.].

Rhythmic auditory stimulation using a portable smart device: short-term effects on gait in chronic hemiplegic stroke patients.

[Purpose] The effects of various rhythmic auditory stimulation tempos on stroke gait pattern changes when training patients with a smartphone-based rhythmic auditory stimulation application were investigated. [Subjects and Methods] Fifteen patients with chronic stroke were included. Cadence during comfortable walking was measured (baseline). After the baseline findings were recorded, rhythmic auditory stimulation with five different tempos (i.e., -10%, -5%, 0%, +5%, and +10% change from baseline) was randomly applied. Finally, comfortable walking without rhythmic auditory stimulation was initiated to evaluate gait pattern changes. [Results] As the tempo increased, the spatiotemporal gait parameters of the stroke patients changed significantly. Gait speed, cadence, and gait cycle duration showed the greatest improvement in the +10% rhythmic auditory stimulation condition compared to baseline. After gait training with rhythmic auditory stimulation, gait speed, cadence, stride length, gait cycle duration, and step length of the affected and unaffected sides improved significantly compared to baseline. [Conclusion] Significant changes in the gait pattern of stroke patients were noted for various tempos after training with rhythmic auditory stimulation. These findings could be used to customize rehabilitative gait training for patients who experience stroke with hemiplegia.

Kinematic analysis of upper extremity movement during drinking in hemiplegic subjects.

BACKGROUND: It is necessary to analyze the kinematic properties of a paralyzed extremity to quantitatively determine the degree of impairment of hemiplegic people during functional activities of daily living (ADL) such as a drinking task. This study aimed to identify the kinematic differences between 16 hemiplegic and 32 able-bodied participants in relation to the task phases when drinking with a cup and the kinematic strategy used during motion with respect to the gravity direction. METHODS: The subjects performed a drinking task that was divided into five phases according to Murphy's phase definition: reaching, forward transport, drinking, backward transport, and returning. We found that the groups differed in terms of the movement times and the joint angles and angular velocities of the shoulder, elbow, and wrist joints. FINDINGS: Compared to the control group, the hemiplegic participants had a larger shoulder abduction angle of at most 17.1° during all the phases, a larger shoulder flexion angle of 7.6° during the reaching phase, and a smaller shoulder flexion angle of 6.4° during the backward transporting phase. Because of these shoulder joint patterns, a smaller elbow pronation peak angle of at most 13.1° and a larger wrist extension peak angle of 12.0° were found in the motions of the hemiplegic participants, as compensation to complete the drinking task. The movement in the gravity direction during the backward transporting phase resulted in a 15.9% larger peak angular velocity for elbow extension in the hemiplegic participants compared to that of the control group. INTERPRETATION: These quantitative kinematic patterns help provide an understanding of the movements of an affected extremity and can be useful in designing rehabilitation robots to assist hemiplegic people with ADL.

Arm motion analysis of stroke patients in activities of daily living tasks: a preliminary study.

Analyzing activities of daily living (ADL) for the development of practical upper limb rehabilitation robots is challenging in stroke patients. Basic ADL tasks using an upper limb are defined based on clinical assessment tools. The motions of 8 healthy participants and 8 stroke patients were recorded during defined ADL tasks, and then analyzed with respect to completion time, linearity of motion, and range of motion of the joints. Completion time and motion trajectories were significantly different between stroke subjects and healthy participants. For tasks involving the transfer of an object from a table to the user's mouth, wrist radial-ulnar deviation motions should be taken into account while designing robots for gross movements via elbow and shoulder joints. Our findings can be extended to the design of trajectories of rehabilitation robots as well as of simplified robots.