'Draw your pelvis' test for assessing pelvic schema in people with Parkinson's disease: a validity and reliability study.

Aim: Body schema (i.e., the mental representation of the body and its parts) is important for cognitive and motor functions, with the pelvis constituting a core element in such schema. Although people with Parkinson's disease exhibit misperceptions and deficits in body schema, there are currently no published tools available for assessing pelvic schema in this population. This study aimed to develop and establish feasibility, reliability, and validity of a novel drawing test - 'Draw Your Pelvis' - for assessing pelvic schema in people with Parkinson's disease. Materials and methods: Twenty people with idiopathic Parkinson's disease (Hoehn &Yahr stages I-III; M age: 65.75 ± 10.13) volunteered and were asked to manually draw a picture of their pelvis. Drawings were assessed and scored by 13 blinded raters over two sessions. Intra- and inter-rater reliability and content and criterion validity were investigated. Results: The 'Draw Your Pelvis' test is shown to be feasible and quick to administer, with excellent inter-rater reliability for consistency (0.954-0.968) and absolute agreement (0.946-0.961). It also demonstrates good-excellent (0.614-0.950) intra-rater reliability, and is content valid. Conclusions: The 'Draw Your Pelvis' test holds potential for clinicians and researchers in assessing pelvic schema and its deficits in people with Parkinson's disease. In addition, this test could be used for investigating the effect of therapeutic interventions on body schema in this population. Future studies should explore this test in additional populations.

Motor Imagery Practice for Enhancing Elevé Performance Among Professional Dancers: A Pilot Study.

OBJECTIVE: Elevé is a core dance movement requiring the greatest ankle plantarflexion (PF) range of motion (ROM). One possible way to enhance elevé performance is by using motor imagery practice (MIP). The aims of this pilot study were to investigate: 1) functional ankle PF maximal angles and ROM while performing elevé among professional dancers, 2) the effect of MIP on enhancing elevé performance, and 3) participants' views on the MIP intervention and its feasibility in a professional dance company setting. METHODS: Five professional dancers, mean age 31 yrs (SD 1.87), participated in a 2-week MIP intervention. Data on ankle PF maximal angles and ROM were collected pre- and post-intervention using 3-dimensional motion capture while performing repeat (10 repetitions) and static (10 sec) elevé. RESULTS: At baseline, ankle PF maximal angles were 169.20° (SD 2.81°) and 168.36° (2.23°) and ankle PF ROM were 40.21° (3.35°) and 35.94° (3.95°) for the repeat and static tasks, respectively. After the MIP intervention, ankle PF maximal angles were 170.28° (4.26°) and 170.74° (3.77°) and ankle PF ROM were 41.53° (2.33°) and 39.30° (2.30°) for the repeat and static tasks, respectively. Feasibility of MIP was established with 100% compliance and positive views were expressed by participants. CONCLUSION: The results suggest MIP holds potential as an adjunct training method for enhancing elevé performance among professional dancers.

EMG activity of finger flexor muscles and grip force following low-dose transcutaneous electrical nerve stimulation in healthy adult subjects.

Somatosensory stimulation modulates cortical and corticospinal excitability and consequently affects motor output. Therefore, low-amplitude transcutaneous electrical nerve stimulation (TENS) has the potential to elicit favorable motor responses. The purpose of the two presented pilot studies was to shed light on TENS parameters that are relevant for the enhancement of two desirable motor outcomes, namely, electromyographic (EMG) activity and contraction strength of the finger flexors and wrist muscles. In 5 and 10 healthy young adults (in Study I and Study II, respectively) TENS was delivered to the volar aspect of the forearm. We manipulated TENS frequency (150 Hz vs. 5 Hz), length of application (10, 20, and 60 min), and side of application (unilateral, right forearm vs. bilateral forearms). EMG amplitude and grip force were measured before (Pre), immediately after (Post), and following 15 min of no stimulation (Study I only). The results indicated that low-frequency bursts of TENS applied to the skin overlying the finger flexor muscles enhance the EMG activity of the finger flexors and grip force. The increase in EMG activity of the flexor muscles was observed after 20 min of stimulation, while grip force was increased only after 1 h. The effects of uni- and bilateral TENS were comparable. These observations allude to a modulatory effect of TENS on the tested motor responses; however, unequivocal conclusions of the findings are hampered by individual differences that affect motor outcomes, such as in level of attention.

Effects of integrated motor imagery practice on gait of individuals with chronic stroke: a half-crossover randomized study.

OBJECTIVES: To test the effects of a new motor imagery practice approach, in which motor and motivational contents were integrated in order to improve gait in subjects with chronic poststroke hemiparesis. DESIGN: A half-crossover study composed of 2 phases. In phase 1, subjects were randomly assigned to receive either the experimental or the control treatment. In phase 2, the subjects who had initially received the control treatment "crossed over" to receive the experimental intervention. SETTING: The experimental and the control intervention were delivered in the subjects' homes; assessments were performed in a hospital laboratory. PARTICIPANTS: Community-dwelling individuals (N=23) with chronic poststroke hemiparesis whose gait was impaired. INTERVENTIONS: The experimental intervention, called integrated motor imagery practice, consisted of imagery scripts aimed at improving home and community walking as well as fall-related self-efficacy. The control treatment consisted of executed exercises to improve the function of the involved upper extremity. MAIN OUTCOME MEASURES: In-home walking, indoor and outdoor community ambulation, and fall-related self-efficacy. These were assessed before and after the intervention as well as at a 2-week follow-up. RESULTS: In-home walking was significantly improved after application of the experimental intervention (P≤.003), but not after the control treatment (P≤.68). Community ambulation did not improve. Fall-related self-efficacy was slightly improved by the integrated motor imagery intervention; however, the findings were not unequivocal. CONCLUSIONS: Home delivery of integrated motor imagery practice was feasible and exerted a positive effect on walking in the home. However, it was ineffective for improving gait in public domains. We speculate that the addition of physical practice to imagery practice may be essential for achieving that end.

Motor imagery practice for improving sit to stand and reaching to grasp in individuals with poststroke hemiparesis.

BACKGROUND: Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production. PURPOSE: To evaluate the effect of motor imagery practice on the performance of sit to stand (STS) and reaching to grasp in subjects with post stroke chronic hemiparesis. METHOD: The study was designed as a crossover intervention. Participants were 13 individuals (mean age, 68.9 [±4.9] years) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah, Israel. Following 1 week of baseline measurements of the performance of STS and reaching to grasp, these functions were mentally practiced for 15 minutes 3 times a week for 4 weeks. Half of the subjects mentally practiced STS, while the other half practiced the reaching imagery protocol. Subsequently, the participants in each group crossed over to practice the second function for the next 4 weeks. All practice sessions were performed according to a pre-established protocol under supervision. Measurements of real performance took place twice before and twice immediately following each practice session. For STS, the Tetrax Balance System was used to measure the speed of performance and weight distribution between the legs. Reaching to grasp was appraised via a "kinematic" glove and included speed variables of the hand. RESULTS: A significant decrease was found in the values of STS duration. Weight distribution between the legs was not affected by the intervention. For reaching to grasp, a significant improvement was found in the mean and the maximum reaching velocity. CONCLUSIONS: In individuals with chronic hemiparesis, the imagery practice of meaningful motor tasks can positively affect real performance.

Intensive intermittent physical therapy in infants with cerebral palsy: a randomized controlled pilot study.

BACKGROUND: The effectiveness of intensive versus standard physical therapy for motor progress in children with cerebral palsy is controversial. Sitting acquisition is considered an important developmental milestone. OBJECTIVES: To assess the acquisition of sitting and gross motor progress in infants with cerebral palsy treated with intermittent intensive physical therapy as compared to a matched group treated with a standard physical therapy regimen. METHODS: We conducted a randomized controlled crossover study in 10 infants aged 12-22 months with cerebral palsy; 5 were assigned to the intensive intermittent therapy group and 5 to the control group. After 4 weeks of baseline intervention, the intervention program was administered to the experimental group for8 weeks and the regularly scheduled weekly program to the comparison group, targeting sitting as the treatment goal. Thereafter the comparison group crossed over. The Gross Motor Function Measure 66 and 88 (GMFM 66 and 88) were used at 4 week intervals. RESULTS: The intermittent intensive regimen yielded a mean improvement of 7.8% as compared to 1.2% with the standard treatment. However, these results were attributed to infants with a low functional level only (P < 0.01). CONCLUSIONS: Goal-directed intensive intermittent regimen could possibly be beneficial in infants with a low functional level.

Metronome rate and walking foot contact time in young adults.

It is assumed that when people walk guided by an audible constant rate, they match foot contact to the external pace. The purpose of this preliminary study was to test that assumption by examining the temporal relationship between audible signals generated by a metronome and foot contact time during gait. Ten healthy young women were tested in walking repetitions guided by metronome rates of 60, 110, and 150 beats/min. Metronome beats and foot contact times were collected in real time. The findings indicated that foot contact was not fully synchronized with the auditory signals; the shortest time interval between the metronome beat and foot contact time was at the prescribed rate of 60 beats/min., while the longest interval was at the rate of 150 beats/min. The correlation between left and right foot contact times was highest with the slowest rate and lowest with the fastest rate.

Associations between treatment processes, patient characteristics, and outcomes in outpatient physical therapy practice.

OBJECTIVE: To identify how treatment processes are related to functional outcomes for patients seeking treatment for musculoskeletal impairments while controlling for demographic and health characteristics at intake. DESIGN: Prospective, observational cohort study. Treatment processes were not altered. Data were collected continuously from June 2005 to January 2008. Descriptive statistics were applied to compare patient characteristics, interventions, and outcomes between impairment categories. Ordinary least-squares multiple regressions were used to examine associations between patient characteristics at intake, treatment processes, and functional outcomes. SETTING: Fifty-four community-based outpatient physical therapy clinics of Maccabi Healthcare Services, a public health plan in Israel. PARTICIPANTS: A consecutive sample of 22,019 adult patients (mean age 51.2 y, standard deviation=15.7, range 18-96, 58% women) seeking treatment due to lumbar spine, knee, cervical spine, or shoulder impairments with functional measurements at intake and discharge. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status at discharge. RESULTS: Explanatory power ranged from 30% to 39%. Better outcomes were associated with patient compliance with self-exercise and therapy attendance, application of therapeutic exercise and manual therapy, and completion of 3 or more functional surveys during the episode of care. Worse outcomes were associated with women, electrotherapy for pain management, and therapeutic ultrasound for shoulder impairments. Mixed results were found for group exercise programs. CONCLUSIONS: The study of associations between treatment processes, patient characteristics, and outcomes helps to describe practice and can be used to suggest ways to improve outcomes in outpatient physical therapy practice.

"Will you draw me a pelvis?Ë® Dynamic neuro-cognitive imagery improves pelvic schema and graphic-metric representation in people with Parkinson's Disease: A randomized controlled trial.

BACKGROUND: Body schema (i.e., the mental representations of the body), vital for motor and cognitive functions, is often distorted in people with Parkinson's disease (PD). Deficits in body, and especially pelvic, schema can further exacerbate motor and cognitive deficits associated with PD. Such deficits, including those in graphic and metric misjudgments, can manifest in drawing tasks. Mental imagery is a recommended approach for PD rehabilitation with potential for ameliorating body schema. OBJECTIVE: To investigate the effect of a two-week dynamic neuro-cognitive imagery (DNI) training versus in-home learning and exercise control (learning/exercise) on pelvic schema and graphic representation (i.e., drawing height and width). DESIGN: Twenty participants with idiopathic PD (Hoehn&Yahr I-III; M age: 65.75 ±â€¯10.13) were randomly allocated into either a DNI or a learning/exercise group. Participants were asked to complete the "Draw Your PelvisË® test in which they drew their pelvis at pre- and post-intervention. Drawings were assessed for pelvic schema score and drawing dimensions (i.e., height and weight). INTERVENTION: DNI anatomical and metaphorical imagery focusing on pelvic anatomy and biomechanics. RESULTS: No difference (p > .05) was detected at baseline between drawn pelvis height and width. Following intervention, improvements were greater in the DNI group for pelvic schema (p < .01), drawn pelvic width (p < .05) and width-height difference (p < .05). CONCLUSIONS: This study suggests that DNI could serve as a rehabilitation path for improving body schema in people with PD. Future studies should explore DNI mechanisms of effect and the effect of enhanced pelvic schema on motor and non-motor deficits in this population.

Psychometric properties of clock and pelvic drawings in Parkinson's disease: A validity and cross-sectional study.

OBJECTIVES: Parkinson's disease (PD) is characterized by visuospatial and body schema deficits. People with PD often exhibit hypometric movements and graphic hypometria (i.e., small drawing dimensions). The goal of the current study was to explore graphic-metric representation in people with PD by assessing pelvic and clock drawing dimensions (i.e., height and width) and by investigating associations between pelvic drawing dimensions and participant characteristics. METHODS: Twenty people (16 males, 4 females; M age: 65.75 ± 10.13 years) with idiopathic PD (Hoehn &Yahr Stages I-III) volunteered to participate in this study. Draw Your Pelvis and Clock Drawing tests were used for assessing drawing dimensions, which were then correlated with PD severity, stage and duration, cognitive level, side of symptoms onset, and pelvic schema score. Bivariate and multiple linear regression analyses were also used. RESULTS: Excellent (.844-.999) interrater reliability was shown for measuring pelvic and clock drawing dimensions. Pelvic drawing dimensions did not significantly (P > .05) differ in magnitude, whereas clock drawing height was significantly (p < .01) greater than width, both suggesting graphic dysmetria (i.e., distorted graphic dimensions). Pelvic drawing width was negatively associated with PD severity and stage, was positively associated with pelvic schema score, and predicted all three parameters. CONCLUSION: Measuring pelvic drawing dimensions, and specifically pelvic drawing width, holds potential as an adjunct diagnostic measure in PD assessments and for detecting pelvic schema deficits or misperceptions. This test can be used by physical therapists in the clinic for assessing disease severity, stage, and pelvic schema in people with PD. The knowledge gained from this study contributes to a greater understanding of graphic-metric representation and associated deficits in people with PD. Future studies should explore the relationship between pelvic drawing dimensions and pelvic mentally imaged estimates, and their role in motor planning, control, and execution in people with PD.

Rehabilitation of gait speed after stroke: a critical review of intervention approaches.

PURPOSE: Walking speed is a cardinal indicator of poststroke gait performance; however, no consensus exists regarding the optimal treatment method(s) for its enhancement. The most widely accepted criterion for establishing the contribution of treatment to walking speed is the gain in speed. The actual speed, however, at the end of the intervention (final speed) may be more important for functional community ambulation. This review examines the contribution of the prevailing methods for gait rehabilitation to final walking speed. METHOD: Walking speed information was derived from studies included in meta-analyses, systematic reviews, and clinical practice guidelines. Recent references, not included in the mentioned sources, were incorporated in cases when gait speed was an outcome variable. Final speed was assessed by the reported speed values and by inferring the capacity for functional community walking at the end of the intervention period. RESULTS: Similar outcomes for final walking speed were found for the different prevailing treatment methods. Treatment gains were likewise comparable and generally insufficient for upgrading patients' functional community walking capacity. CONCLUSIONS: Different treatment methods exist for poststroke gait rehabilitation. Their availability, mode of application, and costs vary, yet outcomes are largely similar. Therefore, choosing an appropriate method may be guided by a pragmatic approach. Simple "low technology" and conventional exercise to date is at least as efficacious as more complex strategies such as treadmill and robotic-based interventions.

Effects of antecedent TENS on EMG activity of the finger flexor muscles and on grip force.

OBJECTIVES: To examine the effects of unilateral and bilateral application of low-dose high-frequency transcutaneous electrical stimulation (TENS) on EMG activity of the finger flexor muscles and on grip force in the right upper extremity. METHODS: Twelve healthy volunteers received unilateral, bilateral, and placebo (zero intensity) TENS stimulation to the finger flexor muscles in three separate sessions. TENS was delivered for 15 min at 100 Hz, with the amplitude adjusted to the sensory threshold. Testing of the right upper extremity was performed in each session prior to stimulation (pre-test), immediately after stimulation (post-test1), and after a 15-min break (post-test2) which followed post-test1. Outcome variables were EMG activation level and maximal grip force. RESULTS: Unilateral and bilateral TENS stimulation were associated with a significant increase in EMG activity of the finger flexors, both at post-test1 and at post-test2, while no change was recorded following the placebo stimulation. The differences between the effects of unilateral vs bilateral stimulation were not significant. Regarding grip force, enhancement at post-test1 was mainly observed following the unilateral and bilateral stimulation, but not after the placebo stimulation. Yet, at post-test2, force enhancement was significant for all three stimulation conditions. CONCLUSIONS: The application of 15 min of TENS stimulation may contribute to subsequent muscular activation level and voluntary force production. Significance. The findings of this preliminary study justify further research on the clinical potential of TENS stimulation to affect voluntary motor output during rehabilitation.

Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis.

OBJECTIVE: To test the feasibility and efficacy of a home-based motor imagery gait training program to improve walking performance of individuals with chronic poststroke hemiparesis. DESIGN: Nonrandomized controlled trial. SETTING: Local facility. PARTICIPANTS: Participants (N=17) were community-dwelling volunteers with hemiparesis caused by a unilateral stroke that occurred at least 3 months before the study. INTERVENTION: Participants received 15 minutes of supervised imagery gait training in their homes 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training. Walking ability was evaluated by kinematics and functional scales twice before the intervention, 3 and 6 weeks after the intervention began, and at the 3-week follow-up. MAIN OUTCOME MEASURES: Spatiotemporal, kinematic, and functional walking measurements. RESULTS: Walking speed increased significantly by 40% after training, and the gains were largely maintained at the 3-week follow-up. The effect size of the intervention on walking speed was moderate (.64). There were significant increases in stride length, cadence, and single-support time of the affected lower limb, whereas double-support time was decreased. Improvements were also noted on the gait scale of the Tinetti Performance-Oriented Mobility Assessment as well as in functional gait. Sixty-five percent of the participants advanced 1 walking category in the Modified Functional Walking Categories Index. CONCLUSIONS: Although further study is recommended, the findings support the feasibility and justify the incorporation of home-based motor imagery exercises to improve walking skills for poststroke hemiparesis.

Implementing an integrated electronic outcomes and electronic health record process to create a foundation for clinical practice improvement.

BACKGROUND AND PURPOSE: Improving clinical outcomes requires continuous measurement and interpretation in conjunction with treatment process and patient characteristics. The purposes of this study were: (1) to describe implementation and integration of electronic functional status outcomes into an electronic health record (EHR) for the promotion of clinical practice improvement processes and (2) to examine the effect of ongoing outcomes data collection in a large physical therapy service in relation to patient and clinic burden. SUBJECTS: Data were examined from 21,523 adult patients (mean age=50.6 years, SD=16.3, range=18-99; 58.9% women, 41.1% men) referred for physical therapist management of neuromusculoskeletal disorders. METHODS: Process and patient characteristic data were entered into the EHR. OUTCOMES: data collected using computerized adaptive testing technology in 11 outpatient clinics were integrated into the EHR. The effect of data collection was assessed by measuring the participation rate, completion rate, and data entry time. Qualitative assessment of the implementation process was conducted. RESULTS: After 1 year, the average participation rate per clinic was 79.8% (range=52.7%-100%), the average completion rate per clinic was 45.1% (range=19.3%-64.7%), and the average data entry time per patient (minutes:seconds) was 03:37 (SD=02:19). Maximum estimate of average administrative time per patient was 9.6% of overall episode time. Barriers to and facilitators of the implementation process were identified. DISCUSSION AND CONCLUSION: The results indicate that routine collection of outcome data is realistic in a large public physical therapy service and can be successfully integrated with EHR data to produce a valuable clinical practice improvement platform for service evaluation and outcomes research. Participation and completion rate goals of 90% and 65%, respectively, appear to be feasible.

Kinematic and Kinetic Analysis of Repeated and Static Elevé in Adolescent Female Dance Students.

Elevé is a fundamental dance movement practiced routinely by dance students and serving as an integral component of screening in dance. It consists of ankle plantar flexion (PF) movement and is considered to be a frequent cause of foot and ankle injuries among dancers, with adolescent female dance students being at greatest risk for such injuries. Therefore, gaining additional knowledge regarding elevé functional range of motion (ROM) and inter-leg weightbearing distribution (WBD) properties among adolescent dance students is warranted for pedagogic, screening, injury prevention, and rehabilitation purposes. The aims of this study were three-fold: 1. to report and compare dance-specific, functional kinematic (ankle PF maximum angle and ankle PF ROM), kinetic (inter-leg WBD), and self-reported level of difficulty (balance, muscular force, and concentration) properties of repeated and static elevé among adolescent female dance students; 2. to look for correlations between elevé properties and participants' demographics (age, height, weight, dance experience, and leg dominance); and 3. to describe the relationships between the two kinematic properties in both elevé tasks. Twenty-three adolescent female dance students (mean age 13.57 ± 0.50 years) were measured while performing two elevé tasks: 10 repetitions ("repeated elevé task") and 10 consecutive seconds hold ("static elevé task"). Data regarding ankle motion and WBD were collected and analyzed using three-dimensional motion capture and two force plates. The data gained from this study expand our current understanding of elevé dance movement and may contribute to clinical relevancy and applicability of screening procedures being conducted in pre-professional dance settings. This may help to identify adolescent dance students with the potential to undertake a career in professional dance as well as to investigate the parameters associated with risk of ankle injuries in this population.

Integration of motor imagery and physical practice in group treatment applied to subjects with Parkinson's disease.

BACKGROUND AND PURPOSE: The application of motor imagery practice in the treatment of Parkinson's disease (PD) is a novel treatment approach for improving motor function. The purpose of this study was to compare group treatment using a combination of physical and motor imagery practice with group treatment using only physical practice in subjects with PD. METHODS: Of 23 patients with idiopathic PD, 12 received combined therapy, whereas 11 received physical therapy alone. Exercises for both groups were applied during 1-h sessions held twice a week for 12 weeks. Comparable motor tasks provided to both groups included callisthenic exercises, functional tasks, and relaxation exercises. However, the experimental group was treated with both imagery and real practice, whereas the control group received only physical exercises. Outcome measures included the time required to complete sequences of movements, the performance of balance tasks, impairment and functional scores on the Unified Parkinson's Disease Rating Scale (UPDRS), and specific cognitive abilities (Stroop and clock drawing tests). RESULTS: Following the intervention, the combined treatment group exhibited significantly faster performance of movement sequences than the control group. In addition, the experimental subjects demonstrated higher gains in the mental and motor subsets of the UPDRS and in the cognitive tests. Both groups improved on the activities of daily living scale. CONCLUSIONS: The combination of motor imagery and real practice may be effective in the treatment of PD, especially for reducing bradykinesia. The implementation of this treatment regimen allows for the extension of practice time with negligible risk and low cost.

Motor imagery in physical therapist practice.

Motor imagery is the mental representation of movement without any body movement. Abundant evidence on the positive effects of motor imagery practice on motor performance and learning in athletes, people who are healthy, and people with neurological conditions (eg, stroke, spinal cord injury, Parkinson disease) has been published. The purpose of this update is to synthesize the relevant literature about motor imagery in order to facilitate its integration into physical therapist practice. This update also will discuss visual and kinesthetic motor imagery, factors that modify motor imagery practice, the design of motor imagery protocols, and potential applications of motor imagery.

TENS to the lateral aspect of the knees during stance attenuates postural sway in young adults.

Somatosensory input is known to be essential for postural control. The present study examined the effects on postural sway of sensory input delivered via transcutaneous electrical nerve stimulation (TENS) applied to the knees during stance. Electrodes from a dual-channel portable TENS unit were adhered to the skin overlying the lateral and medial aspect of both knees of 20 young healthy volunteers (mean age 24.0 years, standard deviation 4.0). Postural sway parameters were obtained during static bipedal stance with an AMTI force platform. Four stimulation conditions were tested with eyes open and with eyes closed: no TENS; TENS applied bilaterally; and TENS applied to either the right or the left knee. Participants underwent two eight-trial blocks, with each trial lasting 30 seconds. The order of conditions was randomized for each participant. Stimulation consisted of a biphasic symmetrical stimulus delivered at the sensory detection level, with a pulse duration of 200microsec and a pulse frequency of 100Hz. The application of TENS induced significant reductions in mean sway velocity and in the medio-lateral dispersion of the center of pressure, with no corresponding effect on the anterior-posterior dispersion. These findings suggest that electrical stimulation delivered at the sensory detection level to the lateral aspects of the knees may be effective in improving balance control, and that this effect may be directionally specific.

External validity of post-stroke interventional gait rehabilitation studies.

Gait rehabilitation is a major component of stroke rehabilitation, and is supported by extensive research. The objective of this review was to examine the external validity of intervention studies aimed at improving gait in individuals post-stroke. To that end, two aspects of these studies were assessed: subjects' exclusion criteria and the ecological validity of the intervention, as manifested by the intervention's technological complexity and delivery setting. Additionally, we examined whether the target population as inferred from the titles/abstracts is broader than the population actually represented by the reported samples. METHODS: We systematically researched PubMed for intervention studies to improve gait post-stroke, working backwards from the beginning of 2014. Exclusion criteria, the technological complexity of the intervention (defined as either elaborate or simple), setting, and description of the target population in the titles/abstracts were recorded. RESULTS: Fifty-two studies were reviewed. The samples were exclusive, with recurrent stroke, co-morbidities, cognitive status, walking level, and residency being major reasons for exclusion. In one half of the studies, the intervention was elaborate. Descriptions of participants in the title/abstract in almost one half of the studies included only the diagnosis (stroke or comparable terms) and its stage (acute, subacute, and chronic). CONCLUSIONS: The external validity of a substantial number of intervention studies about rehabilitation of gait post-stroke appears to be limited by exclusivity of the samples as well as by deficiencies in ecological validity of the interventions. These limitations are not accurately reflected in the titles or abstracts of the studies.

TENS to the posterior aspect of the legs decreases postural sway during stance.

The purpose of this study was to examine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) applied to the posterior aspect of the legs, on postural sway during stance. Thirty healthy subjects were tested while standing on a force platform under four stimulation conditions: no TENS, bilateral TENS, and unilateral left and right TENS. Thirty-second long tests, employing detection threshold amplitudes, were performed in three blocks. In each block, the four conditions were applied both with and without vision in a random order. The results indicate that the application of TENS brought about a decrease in postural sway as expressed by average sway velocity, in addition to a decrease in the absolute values of maximal and minimal medio-lateral and anterior-posterior velocity. Thus, similar to sub-threshold random electrical noise, it appears that the application of low-amplitude TENS to the lower limbs decreases postural sway during stance. Considering the ease of TENS application and the high prevalence of postural disorders, the potential clinical significance of this observation is to be determined by further studies.