Change in Center of Pressure Progression in the Foot Provides Clues for Functional Improvement of the More Affected Lower Limb During Post-stroke Gait Rehabilitation.

OBJECTIVE: The aim of this study was to determine the clinical significance of the anterior-posterior displacement of the center of pressure in the foot (apCoP) in post-stroke gait rehabilitation. DESIGN: This observational study was conducted in a tertiary hospital. Forty-two subacute post-stroke patients were included. The apCoP was measured twice with a wearable insole foot pressure measurement system, time interval more than 7 days. The results were compared between the first and second tests. The relationship between apCoP changes and spatiotemporal parameter changes were investigated. RESULTS: The apCoP increased significantly between tests. The change in walking speed was significantly predicted by the change in the apCoP on the less affected side. The change in asymmetry of the single support phase was significantly correlated with the change in the apCoP on the more affected side. CONCLUSION: The change in apCoP provides information about the restoration of body support, body forward progression control, and propulsion in the more affected lower limb during early post-stroke rehabilitation. The apCoP can be a useful parameter for the monitoring of functional changes in the more affected lower limb during post-stroke gait rehabilitation.

Asymmetry and Variability Should Be Included in the Assessment of Gait Function in Poststroke Hemiplegia With Independent Ambulation During Early Rehabilitation.

OBJECTIVE: To extract independent features from spatiotemporal data of poststroke gait. DESIGN: Retrospective observational study. SETTING: Motion analysis laboratory in the rehabilitation department of a university hospital. PARTICIPANTS: Convenience sample from inpatients in subacute recovery stage post stroke. Of 98 patients post stroke who underwent gait assessment, 69 patients post stroke were included in the data analysis (N=69). They could walk more than 10 m without personal assist or assistive devices. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Spatiotemporal parameters during level walking and their asymmetry and variability were obtained by insole foot pressure measurement system. RESULTS: Of independent components extracted by principal component analysis, 3 independent components explained 81.9% of total variance of spatiotemporal poststroke gait data. The first component has associations with walking speed and proportion of double support phase, and it explains 46.6% of total variance. The second component has association with temporal asymmetry, and it explains 21.1% of total variance. The third component has association with temporal variability, and it explains 14.2% of total variance. Principal component scores did not show significant differences between stroke types and among stroke lesions. CONCLUSIONS: Temporal asymmetry and variability should be included in the assessment of poststroke gait during early rehabilitation. They are independent of each other and provide characteristics of poststroke gait that are independent to the walking speed. They are helpful for rehabilitation planning and developing treatment strategy in poststroke gait rehabilitation.

Sonoanatomy of the deep branch of the ulnar nerve.

INTRODUCTION: This study evaluated the sonoanatomy of the deep motor branch of the ulnar nerve (DBUN) using high-resolution ultrasonography (HRUS). METHODS: In 60 wrists of 30 healthy adults, the gross course, cross-sectional area (CSA), and diameter of the DBUN were observed by HRUS (frequency band 3-16 MHz). Its course was assessed by using the distance from anatomical landmarks and depth from the skin. RESULTS: The DBUN was found in all subjects with HRUS, and it branched off from the ulnar nerve before reaching the hamate bone. At the hook-of-hamate level, the mean DBUN CSA was 1.5 ± 0.2 mm2 , and the mean diameter was 1.5 ± 0.2 mm. The mean distance from the hamate hook to the DBUN was 5.4 ± 1.0 mm, and the mean depth from the skin was 8.6 ± 1.6 mm. DISCUSSION: Sonoanatomy of the DBUN obtained from HRUS may be useful in detecting or preventing DBUN lesions.

Pilot study: Differences in echo intensity ratios between ulnar and median innervated muscles in ulnar neuropathy.

BACKGROUND: This study evaluated muscle echo intensity (EI) ratio in patients with ulnar neuropathy at the elbow (UNE) and healthy controls. METHODS: In this prospective study, 28 patients with electrodiagnostically confirmed unilateral UNE and 12 healthy controls were ultrasonographically assessed for EI ratios of the hypothenar and thenar muscles. The affected and unaffected hands between the UNE patients and controls and patient subgroups (subdivided according to electrodiagnostic severity) were compared to determine any significant differences. RESULTS: In patients with UNE, the EI ratio of the hypothenar to thenar muscles was significantly higher for the affected side than for the unaffected side (1.08 ± 0.11 and 0.97 ± 0.18, respectively) or the control group (0.95 ± 0.05). A significant difference in the EI ratio was observed among the subgroups (mild vs. severe subgroup, P < 0.01). CONCLUSIONS: Ultrasonographic EI measurement may be a useful parameter in the evaluation and screening of UNE.

Could Ultrasound-Guided Stimulation of Sural Nerve Affect Nerve Conduction Study?

OBJECTIVE: To determine anatomical variation of the sural nerve (SN) by ultrasonography (US) and compare sensory nerve action potential (SNAP) of the SN obtained by a control method to that obtained with adjusted method using US. METHODS: Eighty legs of 40 healthy volunteers were enrolled. The location and formation of SN were investigated through US. Two methods of nerve conduction study (NCS) were then performed. In the control method, the cathode was placed 14 cm proximal to the lateral malleolus and the greatest SNAP amplitude was obtained by moving the cathode medially or laterally from just lateral to the calf-mid line. In adjusted NCS, the exact SN union site was stimulated in type 1. In other SN types, the stimulation was done directly over the nerve and the distance from the lateral malleolus was set to be 14 cm. RESULTS: It was found that 73.8% of the SNs were type 1, 22.5% were direct continuation of MSCN (type 2), and 3.8% were MSCN and LSCN without communicating (type 4). However, type 3 was not found. The union point in type 1 SN was 12.6±2.5 cm proximal to the lateral malleolus and 1.4±0.7 cm lateral to the calf-midline. After stimulation adjustment, SNAP amplitude in type 1 SN was significantly increased (20.7±5.5 µV vs. 27.1±6.7 µV). CONCLUSION: Anatomical variation of SN and its location were verified by US. US provides additional information for conducting sural NCS and helps obtain more accurate. RESULTS: .

Anterior-posterior displacement of center of pressure measured by insole foot pressure measurement system in subacute recovery stage of post-stroke hemiplegia.

BACKGROUND: Anterior-posterior displacement of center of pressure (AP_CoP) reflects stance limb function. However, AP_CoP's clinical applicability in post-stroke hemiplegia is unclear. OBJECTIVE: To investigate the clinical usefulness of parameters from AP_CoP in subacute stage post-stroke hemiplegia, their relationships with usage of gait aid, functional ambulatory category, and spatial-temporal parameters were tested. METHODS: Nineteen participants with post-stroke hemiplegia were included in gait with aid group. Twenty one participants were included in gait with independence group. Twenty one participants were included in control group. Insole foot pressure measurement system was used to measure AP_CoP and spatial-temporal parameters. Effects of gait aid usage and functional ambulatory category on AP_CoP were tested with ANOVA. Relationships between AP_CoP and temporo-spatial parameters were investigated with correlation and linear regression analysis. RESULTS: AP_CoP parameters were shorter in gait with aid group than gait with independence group. With better functional ambulatory category, AP_CoP were longer. AP_CoP showed positive relationship with walking speed. AP_CoP in more affected side showed positive relationship with symmetry of single support phase proportion. AP_CoP showed positive relationship with stride length. CONCLUSIONS: AP_CoP reflects overall gait function, impairments in more affected side and adaptation in less affected side in subacute recovery stage of post-stroke hemiplegia. It can be used as a clinically significant parameter for gait rehabilitation.

Carpal Tunnel Syndrome Assessment With Ultrasonography: A Comparison Between Non-diabetic and Diabetic Patients.

OBJECTIVE: To investigate the diagnostic value of cross-sectional area (CSA) and wrist to forearm ratio (WFR) in patients with electro-diagnosed carpal tunnel syndrome (CTS) with or without diabetes mellitus (DM). METHODS: We retrospectively studied 256 CTS wrists and 77 healthy wrists in a single center between January 1, 2008 and January 1, 2013. The CSA and WFR were calculated for each wrist. Patients were classified into four groups according to the presence of DM and CTS: group 1, non-DM and non-CTS patients; group 2, non-DM and CTS patients; group 3, DM and non-CTS patients; and group 4, DM and CTS patients. To determine the optimal cut-off value, receiver operating characteristic (ROC) curve analysis was performed. RESULTS: The CSA and WFR were significantly different among the groups (p<0.001). The ROC curve analysis of non-DM patients revealed CSA ≥10.0 mm2 and WFR ≥1.52 as the most powerful diagnostic values of CTS. The ROC curve analysis revealed CSA ≥12.5 mm2 and WFR ≥1.87 as the most powerful diagnostic values of CTS. CONCLUSION: Ultrasonographic assessment for the diagnosis of CTS requires a particular cut-off value for diabetic patients. Based on the ROC analysis results, improved accurate diagnosis is possible if WFR can be applied regardless of presence or absence of DM.