Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

The effectiveness of a 6-week biofeedback gait retraining programme in people with knee osteoarthritis: protocol for a randomised controlled trial.

BACKGROUND: Gait retraining is a common therapeutic intervention that can alter gait characteristics to reduce knee loading in knee osteoarthritis populations. It can be enhanced when combined with biofeedback that provides real-time information about the users' gait, either directly (i.e. knee moment feedback) or indirectly (i.e. gait pattern feedback). However, it is unknown which types of biofeedback are more effective at reducing knee loading, and also how the changes in gait affect pain during different activities of daily living. Therefore, this study aims to evaluate the acute (6 weeks of training) and chronic (1 month post training) effects of biofeedback based on personalised gait patterns to reduce knee loading and pain in people with knee osteoarthritis, as well as examine if more than one session of knee moment feedback is needed to optimise the gait patterns. METHODS: This is a parallel group, randomised controlled trial in a symptomatic knee osteoarthritis population in which participants will be randomised into either a knee moment biofeedback group (n = 20), a gait pattern biofeedback group (n = 20) or a control group (n = 10). Supervised training sessions will be carried out weekly for six continuous weeks, with real-time biofeedback provided using marker-based motion capture and an instrumented treadmill. Baseline, post-intervention and 1-month follow-up assessments will be performed to measure knee loading parameters, gait pattern parameters, muscle activation, knee pain and functional ability. DISCUSSION: This study will identify the optimal gait patterns for participants' gait retraining and compare the effectiveness of gait pattern biofeedback to a control group in reducing knee loading and index knee pain. Additionally, this study will explore how many sessions are needed to identify the optimal gait pattern with knee moment feedback. Results will be disseminated in future peer-reviewed journal articles, conference presentations and internet media to a wide audience of clinicians, physiotherapists, researchers and individuals with knee osteoarthritis. TRIAL REGISTRATION: This study was retrospectively registered under the International Standard Randomised Controlled Trial Number registry on 7th March 2023 (ISRCTN28045513).

Imagery Rescripting as a stand-alone treatment for posttraumatic stress disorder related to childhood abuse: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) related to childhood abuse (CA) is associated with high symptom complexity. This study examined the efficacy of Imagery Rescripting (ImRs) as a stand-alone treatment versus a sequenced approach with Skills training in Affective and Interpersonal Regulation (STAIR) followed by ImRs for CA-related PTSD. METHODS: Outpatients of two mental health clinics with CA-related PTSD (N = 61) were randomly assigned to ImRs (16 sessions; n = 21), STAIR/ImRs (8 STAIR-sessions followed by 16 ImRs-sessions; n = 20), or Waitlist (8 weeks; n = 20). Patients of the waitlist condition were also randomized to the two active conditions for comparison of STAIR/ImRs (total n for this condition = 31) and ImRs (total n for this condition = 30) and started treatment after waitlist completion. Assessments took place at pre-treatment, after each treatment phase and at 12-week post-intervention follow-up. PTSD symptoms and diagnosis were primary outcome measures, and depression, emotion regulation and interpersonal functioning were secondary outcomes. RESULTS: ImRs showed greater reduction of PTSD severity (effect sizes [ES] 1.40-1.63) than STAIR (ES, 0.23-0.33) as compared to waitlist. When comparing STAIR/ImRs and ImRs directly, (i.e. including re-randomized Waitlist-patients), PTSD symptoms reduced significantly (within condition ES, 1.64-2.10) and improved further to 12-week follow-up (within-condition ES, 2.33-2.66), with no significant difference between both conditions (between-condition ES, 0.21-0.45). Loss of PTSD diagnosis was achieved by 70% in the ImRs condition and 86% in the STAIR/ImRs condition. LIMITATIONS: The sample size was relatively small. CONCLUSIONS: Results show that ImRs is an effective treatment for CA-related PTSD, whereby the current data do not convincingly show an additive effect of STAIR.

Stair-step strategy and immunomodulatory feed ingredient supplementation for grazing heat-stressed Bos indicus-influenced beef heifers.

On day 0 of years 1 and 2, 64 Brangus crossbred heifers per year were stratified by initial body weight (BW) and age (mean = 257 ± 20 kg and 271 ± 22 d) and allocated into 16 bahiagrass (Paspalum notatum) pastures (4 heifers per pasture per yr). Treatments were randomly allotted to pastures in a 2 × 2 factorial arrangement of treatments (4 pastures per treatment per yr). Treatments consisted of concentrate dry matter (DM) supplementation at 1.50% of BW from days 0 to 100 (CON) or concentrate DM supplementation at 1.05% of BW from days 0 to 49 and 1.95% of BW from days 50 to 100 (SST). Then, each respective supplementation strategy was added or not with immunomodulatory feed ingredients from days 0 to 100 (OMN; 4 g/45 kg of BW). Heifers were assigned to an estrus synchronization protocol from days 100 to 114. Heifers detected in estrus from days 111 to 114 were inseminated (AI) 12 h after estrus detection. Heifers not detected in estrus were timed AI on day 114. All heifers were exposed to Angus bulls from days 120 to 210 (1 bull per pasture). Effects of supplementation strategy × OMN inclusion × hour were detected (P < 0.0001) only for intravaginal temperature from days 26 to 30, which were the least (P ≤ 0.03) for SST heifers offered OMN supplementation and did not differ (P ≥ 0.17) among all remaining treatments from 0830 to 1600 hours. Effects of supplementation strategy × OMN inclusion and OMN inclusion were not detected (P ≥ 0.12) for any variable, except for the percentage of heifers detected in estrus, which was greater (P = 0.01) for heifers supplemented with vs. without OMN. Total concentrate DM offered from days 0 to 100 and heifer BW on days 0 and 56 did not differ (P ≥ 0.49) between CON and SST heifers, but SST heifers were heavier (P ≤ 0.01) on days 100 and 210 compared with CON heifers. Body surface temperature on day 25 and plasma IGF-1 concentrations on day 75 were greater (P ≤ 0.04) for SST vs. CON heifers. Percentage of pubertal heifers, heifers detected in estrus, and pregnancy to AI did not differ (P = 0.36) between SST and CON heifers but the final pregnancy percentage was greater (P = 0.04) for SST vs. CON heifers. Thus, OMN supplementation decreased the intravaginal temperature of SST heifers but failed to improve their growth and reproduction, whereas the SST strategy improved body thermoregulation, growth, and final pregnancy percentage of heat-stressed Bos indicus-influenced beef heifers compared with a constant concentrate supplementation strategy.

In Bos taurus beef heifers, altering the timing of body weight (BW) growth pattern either reduced feed costs without decreasing reproduction or enhanced reproduction without increasing feed costs. Moreover, supplementation of OmniGen-AF (OMN, a patented immunomodulatory feed ingredient) decreased internal body temperature in dairy and beef B. taurus cattle, with variable impacts on growth and reproduction. Combining both nutritional strategies for Bos indicus-beef heifers developed under heat stress conditions of tropical and subtropical environments has not been reported in the literature yet and was the main objective of the present study. For 100 d before the breeding season, heifers received either a constant supplementation amount or stair-step (SST) supplementation strategy (50 d of low followed by 50 d of high supplement amount), with or without OMN inclusion. Overall, OMN supplementation alleviated the internal body temperature of heifers but did not improve their growth and reproduction, whereas the SST strategy increased BW gain and final pregnancy percentage of B. indicus-influenced beef heifers under heat stress conditions.

Effect of whole-body vibration on obstacle clearance and stair negotiation time in chronic stroke patients; A randomized controlled trial.

OBJECTIVE: To assess the effect of Whole-Body Vibration (WBV) and Routine Physiotherapy (RP) on obstacle crossing and stair negotiation time in chronic stroke patients. METHODS: The current study was randomized, parallel-group, assessor-blinded, clinical trial conducted in Physiotherapy Department of Lahore General Hospital, involving 64 patients with chronic stroke. Patients were randomly allocated to 2 groups, i.e., the WBV group (n = 32) and the RP group (n = 32). The WBV group was given additional twelve sessions of vibration therapy (amplitude of 3 mm and frequency of 20 Hz), 6 days/week for 2 weeks. The outcome measures were change in score of height and depth of obstacles cleared, i.e., 6, 8, 10 & 12 inches height and 6, 8, 10 & 12 inches depth and stair negotiation time, i.e., Stair-Climb Test. Chi square test, Independent sample t-test and Paired sample t-test were used to analyze the data. RESULTS: Results show that higher number of patients improved in crossing the maximum height and maximum depth of obstacles in the WBV group but improvement was significant only in height, i.e., (p < 0.05). In the WBV group, Stair Negotiation Time decreased significantly as compared to the RP group, i.e., (p < 0.05). CONCLUSIONS: The present study concluded that both study groups, i.e., RP and WBV, improved despite better results for the latter. Speed of stair climbing and capacity to cross obstacles improved with the WBV therapy in chronic stroke survivors. TRIAL REGISTRATION: IRCT, IRCT20190328043131N1. Registered 03 august 2019 - Retrospectively registered, https://www.irct.ir/user/trial/38832/view.

Effects of tai chi on postural control during dual-task stair negotiation in knee osteoarthritis: a randomised controlled trial protocol.

INTRODUCTION: Stair ascent and descent require complex integration between sensory and motor systems; individuals with knee osteoarthritis (KOA) have an elevated risk for falls and fall injuries, which may be in part due to poor dynamic postural control during locomotion. Tai chi exercise has been shown to reduce fall risks in the ageing population and is recommended as one of the non-pharmocological therapies for people with KOA. However, neuromuscular mechanisms underlying the benefits of tai chi for persons with KOA are not clearly understood. Postural control deficits in performing a primary motor task may be more pronounced when required to simultaneously attend to a cognitive task. This single-blind, parallel design randomised controlled trial (RCT) aims to evaluate the effects of a 12-week tai chi programme versus balance and postural control training on neuromechanical characteristics during dual-task stair negotiation. METHODS AND ANALYSIS: Sixty-six participants with KOA will be randomised into either tai chi or balance and postural control training, each at 60 min per session, twice weekly for 12 weeks. Assessed at baseline and 12 weeks (ie, postintervention), the primary outcomes are attention cost and dynamic postural stability during dual-task stair negotiation. Secondary outcomes include balance and proprioception, foot clearances, self-reported symptoms and function. A telephone follow-up to assess symptoms and function will be conducted at 20 weeks. The findings will help determine whether tai chi is beneficial on dynamic stability and in reducing fall risks in older adults with KOA patients in community. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (#2018KY-006-1). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR1800018028.

Restoring physical function after knee replacement: a cross sectional comparison of progressive strengthening vs standard physical therapy.

Objective: The purpose of this study is to compare the functional status of patients 12 months after total knee arthroplasty (TKA) who underwent progressive strengthening or standard of care rehabilitation to older adults without knee joint pain. Methods: This cross-sectional design study included 165 participants in the progressive strengthening group, 40 participants in the standard of care group, and 88 older adults (control group). The Knee Outcome Survey - Activity of Daily Living, knee active range of motion (ROM), quadriceps strength, and performance tests were compared between groups using a one-way ANOVA. The proportions of participants in both TKA groups who achieved the lower bound of the 95% confidence interval of the control group were compared using a Fisher's exact test. Results: Significant between-group effects were found for all variables (p < 0.001). The control group had better outcomes than both the progressive strengthening and standard of care groups (p < 0.001). Compared to the standard of care group, a higher proportion of participants in the progressive strengthening group achieved the lower bound cutoff for active knee extension ROM (p = 0.042), quadriceps strength (p = 0.032), and stair climbing time (p = 0.029). Conclusion: More participants in the progressive strengthening group had physical function that was similar to the healthy control group, when compared to the standard of care group. Progressive strengthening rehabilitation may be more effective in restoring normative levels of function after TKA than standard of care.

Effects of Electro-Acupuncture on Vertical Ground Reaction Force and Impulse Symmetry of Patients with Knee Osteoarthritis during Stair Climbing / 医用生物力学

Objective To observe the effects of electro-acupuncture on loading of lower limb joints in patients with knee osteoarthritis (KOA) during stair climbing and explore the related biomechanical mechanism. Methods Forty patients with KOA were randomly assigned, with 20 patients in observation group (electro-acupuncture group, EA group) and 20 patients in control group (superficial acupuncture group, SA group). Finally 18 patients in each group completed the study. In observation group, seven knee acupuncture points were chosen and patients were connected with electro-acupuncture instrument; while in control group, the electro-acupuncture instrument was connected but not electrified after superficial acupuncture at non-acupoint points. The three-dimensional gait analysis system was used to assess the biomechanical characteristics during stair climbing before and after treatment, including peak vertical force (PFz), vertical impulse (IFz) and symmetry index (SI%). Results After 3 weeks of treatment in EA group, PFz of the right foot during stair ascent and PFz of the left foot during stair descent increased (P＜0.05); IFz of both feet during stair ascent and IFz of the right foot during stairs descent significantly decreased (P＜0.05); no significant differences were found in SI% of peak and impulse (P＞0.05). In SA group, only SI of impulse during stairs ascent increased (P＜0.05). There was no significant difference between two groups before and after treatment (P＞0.05). Conclusions Electro-acupuncture can effectively improve the joint load capacity and reduce the dynamic cumulative load of patients w

Phase-based treatment versus immediate trauma-focused treatment in patients with childhood trauma-related posttraumatic stress disorder: study protocol for a randomized controlled trial.

BACKGROUND: The treatment of posttraumatic stress disorder (PTSD) related to a history of sexual and/or physical abuse in childhood is the subject of international debate, with some favouring a phase-based approach as their preferred treatment, while others argue for immediate trauma-focused treatment. A history of (chronic) traumatisation during childhood has been linked to the development of distinct symptoms that are often labelled as symptoms of complex PTSD. Many therapists associate the presence of symptoms of complex PTSD with a less favourable treatment prognosis. The purpose of this study is to determine whether a phase-based approach is more effective than stand-alone trauma-focused therapy in individuals with PTSD and possible symptoms of complex PTSD resulting from a history of repeated sexual and/or physical abuse in childhood. An additional aim is to investigate moderators, predictors of treatment (non) response and drop-out. METHOD: The sample consists of patients between 18 and 65 years old with a diagnosis of PTSD who report a history of repeated sexual and/or physical abuse in childhood (N = 122). Patients will be blindly allocated to either 16 sessions of eye movement desensitization and reprocessing (EMDR) therapy preceded by a stabilization phase (eight sessions of Skills Training in Affect and Interpersonal Regulation (STAIR)) or only 16 sessions of EMDR therapy. Assessments are carried out pre-treatment, after every eighth session, post-treatment, and at 3 and 6 months follow up. The main parameter will be the severity of PTSD symptoms (PTSD Symptoms Scale-Self Report). Secondary outcome variables are the presence of a PTSD diagnosis (Clinician-Administered PTSD Scale for DSM-5), severity of complex PTSD symptoms (Structured Interview for Disorders of Extreme Stress-Revised and symptoms-specific questionnaires), changes in symptoms of general psychopathology (Brief Symptom Inventory), and quality of life (Euroqol-5D). Health care consumption and productivity loss in patients will also be indexed. DISCUSSION: The study results may help to inform the ongoing debate about whether a phase-based approach has added value over immediate trauma-focused therapy in patients suffering from PTSD due to childhood abuse. Furthermore, the results will contribute to knowledge about the safety, efficacy, and cost-effectiveness of treatments in this target group. TRIAL REGISTRATION: Nederlands Trialregister, NTR5991 . Registered on 23 august 2016. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5991.

Effects of Tai Chi Exercise on body stability among the elderly during stair descent under different levels of illumination.

The elderly are prone to stair descent falls under low illumination. Tai Chi, a traditional Chinese conditioning exercise, has been proved to improve body stability by altering body condition, gait, and proprioception. This study investigates whether Tai Chi exercise could improve body stability during stair descent under high and low illumination. Three groups of elderly women who practice Tai Chi, brisk walking, and no exercise were included. They descended from a simulated staircase. Tai Chi participants decreased horizontal velocity, centre of mass (COM) sway, and increased foot clearance compared with other participants, these movements could increase body stability; Compared with under high illumination, Tai Chi participants decreased horizontal velocity, loading rate, braking impulse, and increased inclination angle, COM sway, centre of pressure displacement under low illumination. Tai Chi participants were more sensitive to the difference in illumination, and took corresponding strategies to stabilize their bodies during stair descent.

Foot exercise and taping in patients with patellofemoral pain and pronated foot.

This study compared the effect of three foot conditions (untreated, short foot [SF] exercise, and Tape) on knee and ankle muscle activity during forward descending of stairs in subjects with patellofemoral pain syndrome (PFPS) and a pronated foot. Surface electromyography activities in the vastus medialis oblique (VMO), vastus lateralis (VL), and abductor hallucis (AbdH) were recorded during forward descending stairs; Surface electromyography data were expressed as percentages of the maximal voluntary isometric contraction. A total of 18 subjects (6 males and 12 females) with PFPS and a pronated foot participated in the current study. The SF exercise was associated with significantly greater AbdH muscle activity compared to the tape condition during forward descending stairs. However, there was no significant difference in VMO or VL muscle activity, or in the VMO/VL muscle activity ratio, among the three foot conditions. The SF exercise was the most effective method of increasing AbdH muscle activity during forward descending stairs in subjects with PFPS and a pronated foot.

Musical Stairs: A motivational therapy tool for children with disabilities featuring automated detection of stair-climbing gait events via inertial sensors.

Stair-climbing is a key component of rehabilitation therapies for children with physical disabilities. This paper reports on the design of a system, Musical Stairs, to provide auditory feedback during stair-climbing therapies. Musical Stairs is composed of two foot-mounted inertial sensors, a step detection algorithm, and an auditory feedback response. In Phase 1, we establish its clinical feasibility via a Wizard-of-Oz AB/BA cross-over design with 17 children, aged 4-6 years, having diverse diagnoses and gait abilities. Self-, therapist- and blinded-observer reports indicated increased motivation with auditory feedback. Phase 2 describes the construction of a database comprised of synchronized video and inertial data associated with 1568 steps up and down stairs completed by 26 children aged 4-6 years with diverse diagnoses and gait. Lastly, in Phase 3, data from 18 children in the database were used to train a rule-based step detection algorithm based on local minima in the acceleration profile and the foot's swing angle. A step detection rate of 96% [SD=3%] and false positive rate of 6% [SD=5%] were achieved with an independent test set (n=8). Recommendations for future development and evaluation are discussed.

[Kinetic mechanism of electroacupuncture for stair climbing in knee osteoarthritis patients].

OBJECTIVE: To observe the kinetic change that reflects joint loading in different planes during stair climbing in knee osteoarthritis (KOA) after electroacupuncture (EA) by three-dimensional motion analysis, so as to provide reference for its biomechanical mechanism treated with acupuncture. METHODS: Forty KOA patients, in accordance with the random number table, were assigned into an observation group and a control group, 20 cases in each one and finally 18 cases completed. Acupoints in the observation group were Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34), Yinlingquan (SP 9), Xuehai (SP 10), Liangqiu (ST 34) and Zusanli (ST 36); points in the control groups were located about 2 cm next to the above acupoints with shallow acupuncture. EA was connected at Neixiyan (EX-LE 4) and Yinlingquan (SP 9), Liangqiu (ST 34) and Yanglingquan (GB 34). The frequency was 2 Hz with continuous wave in the observation group and there was no current in the control group for the corresponding points. All the treatment was given for 3 weeks, totally 11 times. Climbing stairs gait was measured before and after treatment. Velocities and kinetic parameters during ascending and descending stairs were analyzed, including flexion and extension peak torques of hip, knee, ankle on the vertical plane, external knee adduction moment on the coronal plane. RESULTS: After treatment in the observation group, velocities during ascending and descending stairs significantly increased (P<0.05, P<0.01); maximal ankle plantar flexor moments during ascending and descending stairs and the second peak external knee adduction moment (PEKAM2) during ascending stairs significantly increased (P<0.05, P<0.01). After treatment in the control group, the first peak external knee adduction moment (PEKAM1) and PEKAM2 during descending stairs were less than those before treatment (P<0.05, P<0.01). In the observation group, the difference value (DV) of velocity before and after treatment was positively correlated to DV in the torque of ankle plantar flexors during ascending stairs in the observation group (r=0.598，P<0.01). Excluding the impact of velocity, the DV of the maximal torque of ankle plantar flexors during ascending stairs didn't show difference in the observation group (P>0.05). CONCLUSION: EA can increase the velocities of ascending and descending stairs of KOA patients. It improves the loading capacity of knee joint on both sagittal and coronary planes. But its effect during ascending may be correlated with the increase of velocity. The mechanism of different effects between EA and minimal acupuncture on joint moments is still unclear and warrants further study.

Kinetic mechanism of electroacupuncture for stair climbing in knee osteoarthritis patients / 中国针灸

<p><b>OBJECTIVE</b>To observe the kinetic change that reflects joint loading in different planes during stair climbing in knee osteoarthritis (KOA) after electroacupuncture (EA) by three-dimensional motion analysis, so as to provide reference for its biomechanical mechanism treated with acupuncture.</p><p><b>METHODS</b>Forty KOA patients, in accordance with the random number table, were assigned into an observation group and a control group, 20 cases in each one and finally 18 cases completed. Acupoints in the observation group were Neixiyan (EX-LE 4), Dubi (ST 35), Yanglingquan (GB 34), Yinlingquan (SP 9), Xuehai (SP 10), Liangqiu (ST 34) and Zusanli (ST 36); points in the control groups were located about 2 cm next to the above acupoints with shallow acupuncture. EA was connected at Neixiyan (EX-LE 4) and Yinlingquan (SP 9), Liangqiu (ST 34) and Yanglingquan (GB 34). The frequency was 2 Hz with continuous wave in the observation group and there was no current in the control group for the corresponding points. All the treatment was given for 3 weeks, totally 11 times. Climbing stairs gait was measured before and after treatment. Velocities and kinetic parameters during ascending and descending stairs were analyzed, including flexion and extension peak torques of hip, knee, ankle on the vertical plane, external knee adduction moment on the coronal plane.</p><p><b>RESULTS</b>After treatment in the observation group, velocities during ascending and descending stairs significantly increased (<0.05,<0.01); maximal ankle plantar flexor moments during ascending and descending stairs and the second peak external knee adduction moment (PEKAM2) during ascending stairs significantly increased (<0.05,<0.01). After treatment in the control group, the first peak external knee adduction moment (PEKAM1) and PEKAM2 during descending stairs were less than those before treatment (<0.05,<0.01). In the observation group, the difference value (DV) of velocity before and after treatment was positively correlated to DV in the torque of ankle plantar flexors during ascending stairs in the observation group (=0.598，<0.01). Excluding the impact of velocity, the DV of the maximal torque of ankle plantar flexors during ascending stairs didn't show difference in the observation group (>0.05).</p><p><b>CONCLUSION</b>EA can increase the velocities of ascending and descending stairs of KOA patients. It improves the loading capacity of knee joint on both sagittal and coronary planes. But its effect during ascending may be correlated with the increase of velocity. The mechanism of different effects between EA and minimal acupuncture on joint moments is still unclear and warrants further study.</p>

Forward stair descent with hybrid neuroprosthesis after paralysis: Single case study demonstrating feasibility.

The ability to negotiate stairs is important for community access and independent mobility but requires more effort and strength than level walking. For this reason, previous attempts to utilize functional neuromuscular stimulation (FNS) to restore stair navigation after spinal cord injury (SCI) have had limited success and are not readily generalizable. Stair descent is particularly challenging because it requires energy absorption via eccentric muscle contractions, a task not easily accomplished with FNS. This article presents the design and initial testing of a hybrid neuroprosthesis with a variable impedance knee mechanism (VIKM-HNP) for stair descent. Using a 16-channel percutaneous FNS system, a muscle activation pattern was synthesized to descend stairs with the VIKM-HNP in a step-by-step fashion. A finite state control system was implemented to deactivate knee extensor stimulation and utilize the VIKM-HNP to absorb energy and regulate descent speed. Feasibility testing was performed on one individual with complete thoracic-level SCI. Stair descent was achieved with maximum upper-limb forces of less than 45% body weight compared with previously reported value of 70% with FNS only. The experiments also provided insight into design requirements for future hybrid systems for stair navigation, the implications of which are discussed.