Combining Optogenetic Stimulation and Motor Training Improves Functional Recovery and Perilesional Cortical Activity.

Background. An ischemic stroke is followed by the remapping of motor representation and extensive changes in cortical excitability involving both hemispheres. Although stimulation of the ipsilesional motor cortex, especially when paired with motor training, facilitates plasticity and functional restoration, the remapping of motor representation of the single and combined treatments is largely unexplored. Objective. We investigated if spatio-temporal features of motor-related cortical activity and the new motor representations are related to the rehabilitative treatment or if they can be specifically associated to functional recovery. Methods. We designed a novel rehabilitative treatment that combines neuro-plasticizing intervention with motor training. In detail, optogenetic stimulation of peri-infarct excitatory neurons expressing Channelrhodopsin 2 was associated with daily motor training on a robotic device. The effectiveness of the combined therapy was compared with spontaneous recovery and with the single treatments (ie optogenetic stimulation or motor training). Results. We found that the extension and localization of the new motor representations are specific to the treatment, where most treatments promote segregation of the motor representation to the peri-infarct region. Interestingly, only the combined therapy promotes both the recovery of forelimb functionality and the rescue of spatio-temporal features of motor-related activity. Functional recovery results from a new excitatory/inhibitory balance between hemispheres as revealed by the augmented motor response flanked by the increased expression of parvalbumin positive neurons in the peri-infarct area. Conclusions. Our findings highlight that functional recovery and restoration of motor-related neuronal activity are not necessarily coupled during post-stroke recovery. Indeed the reestablishment of cortical activation features of calcium transient is distinctive of the most effective therapeutic approach, the combined therapy.

Prospective evaluation of the connected biofeedback EMY Kegel trainer in the management of stress urinary incontinence.

INTRODUCTION: The aim of this study was to evaluate changes in the quality of life with the connected biofeedback EMY Kegel trainer in patients suffering from stress urinary incontinence. Materiel and methods: This was a prospective, single-center, non-comparative study, which took place between September 2019 and October 2020, in the University Hospitals of Strasbourg. Eligible patients were instructed to use the EMY probe for a minimum of 10 min per day for five days per week. To assess quality of life and urinary symptoms, the Contilife and ICIQ-SF scores were completed each month until the final visit (M3). The PGI-I was also completed at 3 months to assess the benefit of the EMY Kegel Trainer. RESULTS: A total of 55 patients were included. At the inclusion visit (M0), the mean Contilife and ICIQ-SF scores were respectively at 6.6 ± 1.5 and 10.5 ± 3.0 points. At the final visit (M3), the mean Contilife score increased to 9.2 ± 1.0, indicating an improvement in quality of life. The mean ICIQ-SF score decreased to 4.2 ± 4.0, indicating an improvement in urinary symptoms. The PGI-I questionnaire identified a positive assessement of the EMY Kegel trainer. On the 55 patients included, 35 (64%) reported completing at least 36 sessions during the study, i.e. an average of 3 sessions per week. CONCLUSIONS: This study suggests that perineal rehabilitation by biofeedback using the EMY Kegel trainer might be beneficial.

A comparison between Qigong exercise and cycle ergometer exercise for the rehabilitation of chronic obstructive pulmonary disease: A pilot randomized controlled trial (CONSORT).

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is associated with significant morbidity and mortality. Exercise training confers health benefits to people with COPD. The purpose of this study was to compare differences in the rehabilitation of COPD between Qigong exercise (QE) and aerobic exercise using a cycle ergometer (CE). METHODS: This study was a randomized single-blind controlled trial. Twenty six participants were recruited and randomized to either the Qigong group or the cycle ergometer group. Both interventions lasted 12 weeks and comprised a 30 minutes supervised training session performed twice a week, that is, 24 sessions in total. The primary outcome measure was the endurance capacity measured by the six-minute walk test (6MWT). The secondary outcome measures were the results of the St. George's Hospital Respiratory Questionnaire (SGRQ) and the COPD assessment test (CAT). RESULTS: Participants in the group that performed aerobic exercise using a cycle ergometer had significantly improved 6MWT (P = .005), SGRQ (P = .029), and CAT (P = .018) results. Participants in the Qigong exercise group had significant changes in 6MWT (P = .033). However, the differences in 6MWT and SGRQ were not statistically significant between the 2 groups. The changes in CAT scores before and after the intervention were significantly different between the 2 groups (P = .020). There were no reports of adverse events during the course of the trial. CONCLUSIONS: There was no difference in the primary outcome between groups. In particular, QE and cycle ergometer exercise had similar rehabilitation effects on the improvement of the cardiopulmonary endurance and quality of life of chronic obstructive pulmonary disease patients. In addition, cycle ergometer exercise may lead to a better trend of improvement in the quality of life and can improve the severity of the clinical symptoms of chronic obstructive pulmonary disease. TRIAL REGISTRATION: ChiCTR-TRC-14004404.

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors.

BACKGROUND: Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing. OBJECTIVE: To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke. METHODS: A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council. RESULTS: All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8). CONCLUSIONS: Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.

Graded motor imagery training as a home exercise program for upper limb motor function in patients with chronic stroke: A randomized controlled trial.

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.

Impact of smart force feedback rehabilitation robot training on upper limb motor function in the subacute stage of stroke.

OBJECTIVE: To explore the impact of rehabilitation robot training (RRT) on upper limb motor function and daily activity ability in patients with stroke. METHODS: Forty patients meeting the inclusion criteria were randomly divided into the treatment group (TRE) and the control group (CON). Group TRE was trained with an upper limb rehabilitation robot and group CON was trained with traditional occupational therapy. The training time was six weeks, and the upper limb function and daily activities were then assessed. RESULTS: (1) There was no statistical significance in the Fugl-Meyer (FM) score, Wolf Motor Function Test (WMFT) score, and Modified Barthel Index (MBI) score between the two groups before treatment (P > 0.05). (2) After treatment, the FM score, WMFT score, and MBI score were significantly higher than before treatment (P < 0.01). (3) There was no significant significance between the two groups after treatment (P > 0.05). CONCLUSIONS: Both RRT and traditional occupational therapy training are useful for the recovery of upper limb motor function and daily life ability in the sub-acute stage of stroke.

Effects of training with a custom-made visual feedback device on balance and functional lower-extremity strength in older adults: A randomized controlled trial.

INTRODUCTION: Training with a slow and sustained mechanical load, such as standing on one leg, is an effective method for improving balance and increasing lower-extremity strength. Also, visual feedback during motor learning is important in facilitating efficient postural responses and balance skills. In this study, a custom-made visual feedback device was invented to provide the training modality and program based on single-leg standing combined with augmented visual feedback training. This study aimed to investigate the effects of visual feedback training using the custom-made visual feedback device on balance and functional lower-extremity strength in older adults. METHODS: Thirty-four independent older adults were randomly allocated to a training group (TG) and a control group (CG). The participants in the TG received training with the custom-made visual feedback device. The training duration was three sessions per week, for four weeks. The participants in the CG continued their routine activities. Balance (static and dynamic balances, and balance confidence) and functional lower-extremity strength were assessed pre- and post-training. RESULTS: Improvements in static balance (sway velocity and limit of balance during one-leg standing with eyes open) and dynamic balance (directional control of limits of stability in the backward direction) were found after training in the TG compared with the CG. No significant differences in balance confidence or functional lower-extremity strength were found between groups after training. CONCLUSION: In older adults, training with a custom-made visual feedback device could be used to improve both static and dynamic balances, but not balance confidence and functional lower-extremity strength.

Lessons from Vienna: stakeholder perceptions of functional electrical stimulation technology and a conceptual model for practice.

Aim: Functional electrical stimulation (FES) is a technology that can be used on paralyzed muscles to allow them to move. It has been used in populations with muscle paralysis or weakness for exercise, such as spinal cord injury (SCI) and multiple sclerosis. In order to improve technology, it is vital to understand from a qualitative perspective, issues surrounding device development and implementation.Materials and Methods: In 2016, a study was conducted at the Medical University of Vienna that sought to unravel perspectives of FES exercise from the perspective of clinicians, engineers and researchers. Semi-structured, qualitative interviews were conducted on a sample of participants from the conference (n = 22). Interviews were transcribed verbatim, and text data were analysed.Results: Following this analysis, a conceptual model of FES application in the home environment was derived. We show that the likelihood of continuing FES over time may be influenced by expectations and initial education, as perceived by stakeholders.Conclusion: This model provides a tool by which researchers or clinicians may implement FES in the home environment and may assist in the increased uptake of FES exercise at home for people who may reap benefits from its use.Implications for RehabilitationFunctional electrical stimulation (FES) is a technology that enables individuals with paralysis, such as Spinal Cord Injury or Multiple Sclerosis, to exercise.Motivation and support networks, along with adequate initial education, are essential should patients be able to successfully use FES for exercise.There are unique issues associated with performing FES in the home, and compliance may be influenced by how patients perceive FES with regard to providing benefits, and what their initial expectations are.Communication and education are essential for all parties involved in the provision of FES treatment, to ensure successful treatment with FES at home.

Distributed Repetitive Learning Control for Cooperative Cadence Tracking in Functional Electrical Stimulation Cycling.

Closed-loop control of functional electrical stimulation coupled with motorized assistance to induce cycling is a rehabilitative strategy that can improve the mobility of people with neurological conditions (NCs). However, robust control methods, which are currently pervasive in the cycling literature, have limited effectiveness due to the use of high stimulation intensity leading to accelerated fatigue during cycling protocols. This paper examines the design of a distributed repetitive learning controller (RLC) that commands an independent learning feedforward term to each of the six stimulated lower-limb muscle groups and an electric motor during the tracking of a periodic cadence trajectory. The switched controller activates lower limb muscles during kinematic efficient regions of the crank cycle and provides motorized assistance only when most needed (i.e., during the portions of the crank cycle where muscles evoke a low torque output). The controller exploits the periodicity of the desired cadence trajectory to learn from previous control inputs for each muscle group and electric motor. A Lyapunov-based stability analysis guarantees asymptotic tracking via an invariance-like corollary for nonsmooth systems. The switched distributed RLC was evaluated in experiments with seven able-bodied individuals and five participants with NCs. A mean root-mean-squared cadence error of 3.58 ± 0.43 revolutions per minute (RPM) (0.07 ± 7.35% average error) and 4.26 ± 0.84 RPM (0.1 ± 8.99% average error) was obtained for the healthy and neurologically impaired populations, respectively.

Praxias bucofonatorias con dispositivos bucales y realidad virtual inmersiva: un estudio piloto / Bucco-phonatory training practices with oral devices and immersive virtual reality: a pilot study

El presente trabajo evalúa la efectividad de una intervención utilizando Praxias bucofonatorias con dispositivos bucales en conjunto con realidad virtual inmersiva (RVI), mediante programas diseñados para estimular estados de relajación e interacción en diferentes ambientes virtuales. Para ello, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y la exposición a imágenes y sonidos empleando RVI en un grupo de 6 niños con el diagnóstico de dislalia. Se comparó los resultados de esta intervención con el de una intervención utilizando únicamente la vibro estimulación bucal palatina en un grupo de 20 niños con diagnóstico de dislalia. Finalmente, se aplicó la terapia integrada de vibro estimulación bucal palatina, ejercitación lingual y RVI en un grupo de niños con autismo. Los resultados observados mostraron que la terapia con dispositivos bucales combinadas con RVI tendía a producir mayores avances que la terapia sin RVI. Además, se observó diferentes grados de avances individuales y grupales en el dominio fonético dependiendo las habilidades de hablainicial, los niños con mejores habilidades presentaban mayores avances. El grupo de niños con autismo presentó menores avances respecto de los otros dos grupos. A pesar de las limitantes del presente estudio (diferente cantidad de sujetos por grupo y distintas edades) puede considerarse esta propuesta como prometedora para futuros estudios.

This study assesses the effectiveness of a therapy using Bucco-phonatory training practices with buccal devices and immersive virtual reality (RVI) through programs designed to stimulate states of relaxation and interaction in different virtual environments. In order to do so, an integrated therapy based on Intra buccal stimulation by means of vibrations in the palatal area, daily lingual exercises with a lingual exerciser device, and exposure to images and sounds using RVI was applied to a group of 6 children diagnosed with dyslalia. The results of this intervention were compared with those obtained in an intervention based only on intra buccal stimulation by means of vibrations in the palatal area (conducted on a a group of 20 children diagnosed with dyslalia). Finally, the integrated therapy of intra buccal stimulation by means of vibrations in the palatal area, lingual exercises, and RVI was applied to a group of children with autism. The results showed that therapy with oral devices combined with RVI tended to produce greater advances than therapy without RVI. In addition, individual differences in group advances in the phonetic domain were observed depending on the initial speech skills, children with better abilities presented greater advances. The group of children with autism progressed less than the other two groups. Even considering the limitations of this study, such as the heterogeneity in terms of group size and age, results can be considered as promising for future studies.

Tongue strength rehabilitation using biofeedback: a case report. / Reabilitação da força da língua utilizando biofeedback: relato de caso.

This research had the objective of reporting a clinical case in which the rehabilitation of tongue strength with biofeedback strategy was performed. This case report addresses a 20-year-old patient whose orofacial myofunctional evaluation revealed a severe decrease in the force of the anterior third of the tongue and changes in lingual mobility and coordination. The measurement of tongue pressure was performed using the Iowa Oral Performance Instrument (IOPI) during elevation, protrusion and lateralization, and it was verified a reduction in the values ​​obtained in all measured directions, compared with normality patterns. We performed 11 sessions of therapy, with weekly frequency, using a biofeedback strategy that consisted of computer games controlled by the tongue. An instrument embedded in the oral cavity functioned as a joystick as the input method for specific digital games. The patient performed at home the isometric exercises of pressing the tip of the tongue against a spatula, exaggerated retraction of tongue, tongue tapering, and isotonic exercise of touching the commissures and lips alternately, daily. After eight sessions, in relation to the elevation pressure, there was an improvement of 28.6% for the apex and 7.1% for the dorsum. As for protrusion, there was an improvement of 123.5%. In the measurements of left and right lateralization, the values ​​increased 53.8% and 7.4%, respectively. After twelve sessions, it was observed an improvement of 35.7%, 7.4%, 164%, 76.9% and 40.7% in relation to the initial evaluation, for apex elevation, dorsum elevation, protrusion, and lateralization to left and right, respectively. Despite the increase, values ​​recommended in the literature as normal for sex and age were not reached after 12 therapy sessions.

Esta pesquisa teve o objetivo de relatar um caso clínico em que foi realizada a reabilitação da força lingual com estratégia de biofeedback. Trata-se de uma paciente de 20 anos de idade, cuja avaliação miofuncional orofacial evidenciou diminuição grave de força do terço anterior da língua e alterações na mobilidade e na coordenação linguais. A quantificação da pressão lingual foi realizada por meio do Iowa Oral Performance Instrument durante a elevação, a protrusão e a lateralização, tendo se verificado redução nos valores obtidos em todas as direções medidas em comparação aos padrões de normalidade. Foram realizadas 11 sessões de terapia, com frequência semanal, utilizando estratégia de biofeedback que consistia em jogos computacionais acionados pela língua. Um instrumento encaixado na cavidade oral funcionava como um joystick, sendo método de entrada para jogos digitais específicos. Em casa, a paciente realizou exercícios isométricos de pressão de ponta de língua contra espátula, retração exagerada de língua, afilamento lingual e isotônico de tocar comissuras e lábios alternadamente, diariamente. Após oito sessões, em relação à pressão na elevação, houve melhora de 28,6% para o ápice e 7,1% para o dorso. Quanto à protrusão, houve melhora de 123,5%. Nas medidas de lateralizações esquerda e direita, os valores aumentaram 53,8% e 7,4%, respectivamente. Após 12 sessões, percebeu-se melhora, em relação à avaliação inicial, de 35,7%, 7,4%, 164%, 76,9% e 40,7%, para elevação de ápice, de dorso, protrusão, lateralizações esquerda e direita, respectivamente. Apesar do aumento, valores preconizados na literatura, como normalidade para o sexo e a idade, não foram atingidos com 12 sessões.

Knee Osteoarthritis: Alternative Range of Motion Treatment.

The number of total knee arthroplasty (TKA) surgeries is expected to soar, and an effective nonoperative rehabilitation program is needed. We began treating patients with knee osteoarthritis with a range-of-motion (ROM) -based rehabilitation program that was delivered systematically, starting with ROM exercises for knee extension, followed by exercises for flexion and swelling reduction, before starting a strengthening program. In a group of 396 patients, significant improvements were made in knee extension, flexion, and KOOS subjective scores for pain, symptoms, activities of daily living, sport, and quality of life. Furthermore, the program prevented 76% of patients from undergoing TKA surgery.

Visual Biofeedback of Force Information for Eccentric Training of Hemiplegic Patients.

Motor learning issues for hemiplegics not only include motor impairments such as spastic paralysis, but reportedly also an inability to appropriately recognize somatic sensations. In this regard, biofeedback of movement information through visual information and auditory information has been found effective as a method for drawing attention to appropriate somatic sensations. In this context, here, we propose a novel eccentric training system utilizing visual biofeedback of force information. We first develop a compact and highly portable rehabilitation robot for home use. The robot estimates the force on the tiptoe without the use of a force sensor, and a display connected to the robot presents the force information to the trainee. Clinical trials with two chronic hemiplegics have been conducted. The results show that the timed up and go tests of both trainees are shortened after training twice a week for three weeks (six times in total). Simultaneously, the co-contraction index scores of the tibialis anterior and gastrocnemius muscles decrease. These findings in conjunction with previous results suggest that training with visual biofeedback of force information may enhance reciprocal inhibition of the tibialis anterior muscle and reduces co-contraction.

Neurotechnology-aided interventions for upper limb motor rehabilitation in severe chronic stroke.

Upper limb motor deficits in severe stroke survivors often remain unresolved over extended time periods. Novel neurotechnologies have the potential to significantly support upper limb motor restoration in severely impaired stroke individuals. Here, we review recent controlled clinical studies and reviews focusing on the mechanisms of action and effectiveness of single and combined technology-aided interventions for upper limb motor rehabilitation after stroke, including robotics, muscular electrical stimulation, brain stimulation and brain computer/machine interfaces. We aim at identifying possible guidance for the optimal use of these new technologies to enhance upper limb motor recovery especially in severe chronic stroke patients. We found that the current literature does not provide enough evidence to support strict guidelines, because of the variability of the procedures for each intervention and of the heterogeneity of the stroke population. The present results confirm that neurotechnology-aided upper limb rehabilitation is promising for severe chronic stroke patients, but the combination of interventions often lacks understanding of single intervention mechanisms of action, which may not reflect the summation of single intervention's effectiveness. Stroke rehabilitation is a long and complex process, and one single intervention administrated in a short time interval cannot have a large impact for motor recovery, especially in severely impaired patients. To design personalized interventions combining or proposing different interventions in sequence, it is necessary to have an excellent understanding of the mechanisms determining the effectiveness of a single treatment in this heterogeneous population of stroke patients. We encourage the identification of objective biomarkers for stroke recovery for patients' stratification and to tailor treatments. Furthermore, the advantage of longitudinal personalized trial designs compared to classical double-blind placebo-controlled clinical trials as the basis for precise personalized stroke rehabilitation medicine is discussed. Finally, we also promote the necessary conceptual change from 'one-suits-all' treatments within in-patient clinical rehabilitation set-ups towards personalized home-based treatment strategies, by adopting novel technologies merging rehabilitation and motor assistance, including implantable ones.

Effects of a training programme of functional electrical stimulation (FES) powered cycling, recreational cycling and goal-directed exercise training on children with cerebral palsy: a randomised controlled trial protocol.

INTRODUCTION: Children with cerebral palsy (CP) experience declines in gross motor ability as they transition from childhood to adolescence, which can result in the loss of ability to perform sit-to-stand transfers, ambulate or participate in leisure activities such as cycling. Functional electrical stimulation (FES) cycling is a novel technology that may provide opportunities for children with CP to strengthen their lower limbs, improve functional independence and increase physical activity participation. The proposed randomised controlled trial will test the efficacy of a training package of FES cycling, adapted cycling and goal-directed functional training to usual care in children with CP who are susceptible to functional declines. METHODS AND ANALYSIS: Forty children with CP (20 per group), aged 6-8 years and classified as Gross Motor Function Classification System (GMFCS) levels II-IV will be recruited across South East Queensland. Participants will be randomised to either an immediate intervention group, who will undertake 8 weeks of training, or a waitlist control group. The training group will attend two 1 hour sessions per week with a physiotherapist, consisting of FES cycling and goal-directed, functional exercises and a 1 hour home exercise programme per week, consisting of recreational cycling. Primary outcomes will be the gross motor function measure and Canadian occupational performance measure, and secondary outcomes will include the five times sit-to-stand test, habitual physical activity (accelerometry), power output during cycling and Participation and Environment Measure-Children and Youth. Outcomes will be assessed at baseline, postintervention (8 weeks) and 8 weeks following the intervention (retention). ETHICS AND DISSEMINATION: Ethical approval has been obtained from Griffith University (2018/037) and the Children's Health Queensland Hospital and Health Service (CHQHHS) Human Research Ethics Committee (HREC/17/QRCH/88). Site-specific approval was obtained from CHQHHS research governance (SSA/17/QRCH/145). Results from this trial will be disseminated via publication in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER: ACTRN12617000644369p.

Effects of training with a neuro-mechano stimulator rehabilitation bicycle on functional recovery and paired-reflex depression of the soleus in individuals with incomplete paralysis: a proof-of-principle study.

Aim: The present study describes the training effects of a novel motorized bicycle-like device for individuals with incomplete spinal cord injury. Methods: Participants were five individuals with motor incomplete spinal cord injury (56 ± 7 years). Four of five participants received two 30-min sessions of training: one with, and one without, mechanical stimulation on the plantar surface of the foot; soleus paired H-reflex depression was examined before and after each session. Three of five participants received 24 sessions of 30-min of training (long-training). Following the long-training, balance, walking and spasticity improvements were assessed using validated clinical outcome measures, in addition to the H-reflex assessment. Results: One cycling session with mechanical stimulation yielded 14% and 32% more reflex depression in participants with moderate spasticity (n = 2/4). The same trend was not observed in non-spastic participants (n = 2/4). All participants who participated in the long-training had spasticity and showed reduced spasticity, improved walking speed, endurance and balance. Conclusions: Overall, participants with spasticity showed increased soleus H-reflex suppression after one training session with mechanical stimulation and reduced spasticity scores after long training. We interpret this as evidence that the training influenced both presynaptic and postsynaptic inhibitory mechanisms acting on soleus motoneurons. Therefore, this training has the potential to be a non-invasive complementary therapy to reduce spasticity after incomplete spinal cord injury.

Videogame assisted exercise training in patients with chronic obstructive pulmonary disease: A preliminary study.

BACKGROUND: Exercise training is key to the comprehensive management of patients with chronic obstructive pulmonary disease (COPD). Interactive game-based systems have been proposed to improve effectiveness and compliance with exercise training. AIM: To evaluate the effectiveness of Wii Fit balance board as an additional tool for exercise training in patients with COPD. As a secondary aim we will evaluate the costs. METHODS: In a randomized controlled trial, patients were divided into experimental (EG) and control (CG) groups. The CG performed exercise training on a cycle ergometer three times a week for 6 weeks. The EG also followed a program (yoga, strength training, aerobic exercise) using the Wii Fit system. Pre and post treatment six-minute walking distance (6MWD) test, transitional dyspnea index (TDI), the Medical Research Council (MRC) score the Saint George's Respiratory Questionnaire (SGRQ), the body max index, airflow obstruction, dyspnea, and exercise capacity index (BODE) were assessed. RESULTS: The 6MWD increased from 410.7 (105.3) to 477.5 (122.4) and from 376.6 (81.0) to 420 (77.6) meters, in CG and EG respectively, p=0.0001 without any difference between groups. Both groups experienced significant improvements in TDI and SGRQ, but not in MRC and BODE, without any significant difference between groups. CONCLUSION: A Wii Fit balance board based video game program was feasible but did not add any benefit to a well conducted standard exercise training program in patients with COPD.

Real-Time Three-Dimensional Knee Moment Estimation in Knee Osteoarthritis: Toward Biodynamic Knee Osteoarthritis Evaluation and Training.

We investigated differences in knee kinetic variables (external knee adduction, flexion, internal rotation moments, and impulses) between patients with knee osteoarthritis (KOA) and healthy controls during stepping on a custom elliptical trainer; and searched knee kinetic variable candidates for real-time biofeedback and for complementing diagnosis/evaluation on the elliptical trainer based on the knee kinetic variables' associations with the knee injury and osteoarthritis outcome score (KOOS). Furthermore, we explored potential gait re-training strategies on the elliptical trainer by investigating the knee kinetic variables' associations with 3-D ankle angles. The knee kinetic variables and ankle angles were determined in real-time in a patient group of 10 patients with KOA and an age-and sex-matched control group of 10 healthy subjects. The mean peak external knee adduction moment of the patient group was 47% higher than that of the control group. The KOOS-Sports and Recreational Activities and KOOS-Pain scores were found to be significantly associated with the knee kinetic variables. All the ankle angles were associated with the knee kinetic variables. The findings support the use of the knee kinetic variables on the elliptical trainer to complement KOA diagnosis quantitatively and provide potential real-time KOA gait re-training strategies/guides.

The effect of stride length on lower extremity joint kinetics at various gait speeds.

Robot-assisted training is a promising tool under development for improving walking function based on repetitive goal-oriented task practice. The challenges in developing the controllers for gait training devices that promote desired changes in gait is complicated by the limited understanding of the human response to robotic input. A possible method of controller formulation can be based on the principle of bio-inspiration, where a robot is controlled to apply the change in joint moment applied by human subjects when they achieve a gait feature of interest. However, it is currently unclear how lower extremity joint moments are modulated by even basic gait spatio-temporal parameters. In this study, we investigated how sagittal plane joint moments are affected by a factorial modulation of two important gait parameters: gait speed and stride length. We present the findings obtained from 20 healthy control subjects walking at various treadmill-imposed speeds and instructed to modulate stride length utilizing real-time visual feedback. Implementing a continuum analysis of inverse-dynamics derived joint moment profiles, we extracted the effects of gait speed and stride length on joint moment throughout the gait cycle. Moreover, we utilized a torque pulse approximation analysis to determine the timing and amplitude of torque pulses that approximate the difference in joint moment profiles between stride length conditions, at all gait speed conditions. Our results show that gait speed has a significant effect on the moment profiles in all joints considered, while stride length has more localized effects, with the main effect observed on the knee moment during stance, and smaller effects observed for the hip joint moment during swing and ankle moment during the loading response. Moreover, our study demonstrated that trailing limb angle, a parameter of interest in programs targeting propulsion at push-off, was significantly correlated with stride length. As such, our study has generated assistance strategies based on pulses of torque suitable for implementation via a wearable exoskeleton with the objective of modulating stride length, and other correlated variables such as trailing limb angle.

Reabilitação da força da língua utilizando biofeedback: relato de caso / Tongue strength rehabilitation using biofeedback: a case report

RESUMO Esta pesquisa teve o objetivo de relatar um caso clínico em que foi realizada a reabilitação da força lingual com estratégia de biofeedback. Trata-se de uma paciente de 20 anos de idade, cuja avaliação miofuncional orofacial evidenciou diminuição grave de força do terço anterior da língua e alterações na mobilidade e na coordenação linguais. A quantificação da pressão lingual foi realizada por meio do Iowa Oral Performance Instrument durante a elevação, a protrusão e a lateralização, tendo se verificado redução nos valores obtidos em todas as direções medidas em comparação aos padrões de normalidade. Foram realizadas 11 sessões de terapia, com frequência semanal, utilizando estratégia de biofeedback que consistia em jogos computacionais acionados pela língua. Um instrumento encaixado na cavidade oral funcionava como um joystick, sendo método de entrada para jogos digitais específicos. Em casa, a paciente realizou exercícios isométricos de pressão de ponta de língua contra espátula, retração exagerada de língua, afilamento lingual e isotônico de tocar comissuras e lábios alternadamente, diariamente. Após oito sessões, em relação à pressão na elevação, houve melhora de 28,6% para o ápice e 7,1% para o dorso. Quanto à protrusão, houve melhora de 123,5%. Nas medidas de lateralizações esquerda e direita, os valores aumentaram 53,8% e 7,4%, respectivamente. Após 12 sessões, percebeu-se melhora, em relação à avaliação inicial, de 35,7%, 7,4%, 164%, 76,9% e 40,7%, para elevação de ápice, de dorso, protrusão, lateralizações esquerda e direita, respectivamente. Apesar do aumento, valores preconizados na literatura, como normalidade para o sexo e a idade, não foram atingidos com 12 sessões.

ABSTRACT This research had the objective of reporting a clinical case in which the rehabilitation of tongue strength with biofeedback strategy was performed. This case report addresses a 20-year-old patient whose orofacial myofunctional evaluation revealed a severe decrease in the force of the anterior third of the tongue and changes in lingual mobility and coordination. The measurement of tongue pressure was performed using the Iowa Oral Performance Instrument (IOPI) during elevation, protrusion and lateralization, and it was verified a reduction in the values ​​obtained in all measured directions, compared with normality patterns. We performed 11 sessions of therapy, with weekly frequency, using a biofeedback strategy that consisted of computer games controlled by the tongue. An instrument embedded in the oral cavity functioned as a joystick as the input method for specific digital games. The patient performed at home the isometric exercises of pressing the tip of the tongue against a spatula, exaggerated retraction of tongue, tongue tapering, and isotonic exercise of touching the commissures and lips alternately, daily. After eight sessions, in relation to the elevation pressure, there was an improvement of 28.6% for the apex and 7.1% for the dorsum. As for protrusion, there was an improvement of 123.5%. In the measurements of left and right lateralization, the values ​​increased 53.8% and 7.4%, respectively. After twelve sessions, it was observed an improvement of 35.7%, 7.4%, 164%, 76.9% and 40.7% in relation to the initial evaluation, for apex elevation, dorsum elevation, protrusion, and lateralization to left and right, respectively. Despite the increase, values ​​recommended in the literature as normal for sex and age were not reached after 12 therapy sessions.