How a personalised transportable folding device for seating impacts dysphagia.

PURPOSE: A personalised transportable folding device for seating (DATP) on a standard seat was developed by an occupational therapist at the Toulouse University Hospital Centre (patent no. WO 2011121249 A1) based on the hypothesis that the use of a seat to assist with better positioning on any chair during meals modifies the sitting posture and has an impact on cervical statics which increases the amplitude of movements of the axial skeleton (larynx and hyoid bone) and benefits swallowing. The aim of this work is to demonstrate that an improvement in sitting posture with the help of the DATP, through Hyoid bone motion, has an impact on the quality of swallowing in a dysphagic population which benefits from the device in comparison to a dysphagic population which does not benefit from the device after 1 month of care. The secondary endpoints concern the evaluation of the impact on other characteristics of swallowing, posture, the acceptability of the device and the quality of life. METHODOLOGY: This is a randomised comparative clinical trial. The blind was not possible for the patients but the examiner who evaluated the outcome criterion was blinded to the group to which the patient belonged. The outcome criterion was the measurement of the hyoid bone movement during swallowing. The other criteria were collected during the videofluoroscopic examination of swallowing and by use of a questionnaire. Fifty-six (56) patients were included: 30 in the group without device (D-) and 26 in the group with the device (D+). All the patients benefited from a training course on seating. Only the D+ patients participated in this course where the use of the device was explained and the device was then kept for use at home for 1 month. RESULTS: A significant improvement was noted in the postural criteria before and after use, in favour of a better posture for the two groups (p < 0.001) and more hyoid bone motion in the D+ group. The difference was significant in the bivariate analysis for horizontal movement (p = 0.04). After adjustment of potential factors of confusion, we noted a significant mean difference for the three distances in the D+ group in comparison to the D- group, of + 0.33 (95% CI [+ 0.17; + 0.48]) for horizontal movement, + 0.22 (95% CI [+ 0.03; + 0.40]) for vertical movement and + 0.37 (95% CI = [+ 0.20; + 0.53]) for horizontal movement. However, the other parameters, and notably the other swallowing markers were not significantly modified by the use of the device. CONCLUSION: The personalised transportable folding device for seating developed to reduce dysphagia has an action on hyoid bone motion during swallowing. However, this positive effect on an intermediate outcome criterion of the quality of swallowing was not associated with an improvement in swallowing efficiency in the study population. The diversity of diseases with which the patients in this study were afflicted is a factor to be controlled in future studies with this device.

Effectiveness of diacutaneous fibrolysis for the treatment of chronic lateral epicondylalgia: a randomized clinical trial.

OBJECTIVE: To assess the end of treatment and three months after treatment effects of diacutaneous fibrolysis as adjuvant of physical therapy for chronic lateral epicondylalgia. DESIGN: Double-blind (patient and evaluator) randomized controlled trial. SETTING: Primary Care Center of the Spanish NHS. SUBJECTS: A total of 54 people with 60 elbows affected with chronic lateral epicondylalgia, 33 women, mean (SD) age was 48.43 (8.69) years. INTERVENTIONS: All three groups (Intervention, Placebo and Control) received three weeks of physical therapy treatment and in addition Intervention Group received six sessions of real diacutaneous fibrolysis and Placebo Group received six sessions of sham diacutaneous fibrolysis. MAIN MEASURES: Pain intensity, pressure pain threshold, pain free grip strength, function and subjective assessment were assessed at baseline, at the end of treatment and three months after treatment. RESULTS: Between-group results at three months after treatment showed a statistically significant improvement of the Intervention Group in pain free grip strength (mean, 7.91 km/cm2; SD, 9.23) compared to the Placebo Group (mean, 1.47 km/cm2; SD, 7.86) and to the Control Group (mean, 2.09 km/cm2; SD, 4.45) ( P values <0.01 and <0.03, respectively) and also in function (mean, 20.87; SD, 14.25) compared to the Control Group (mean, 4.17; SD, 18.02) ( P < 0.01). Subjective assessment was statistically better in the Intervention Group both at the end of treatment ( P < 0.01) and three months after treatment ( P < 0.03). CONCLUSION: Diacutaneous fibrolysis added to physical therapy provides better results in the treatment of chronic lateral epicondylalgia, with greater clinical satisfaction among patients.

Mobilization with movement and kinesio taping in knee arthritis-evaluation and outcomes.

INTRODUCTION: The aim of this study was to investigate the acute effects of Mulligan mobilization with movement (MwM) and taping on function and pain intensity in patients with osteoarthritis (OA). MATERIALS AND METHODS: Female patients aged between 40 and 70 years with knee OA participated in the study. The patients were divided into three groups and each group received different interventions. Group 1 received MwM and taping according to Mulligan's concept. Group 2 received MwM and placebo taping with no recovery effect and group 3 received placebo taping. Functional tests including lifting, picking up, sit and stand-up, socket tests in addition to climbing up and down stairs, ten metres walk, and timed up and go (TUG) tests were performed before and after intervention. Pain during the test performances were assessed by a visual analog scale. RESULTS: Performance in all tests improved significantly in the MwM + taping group, while only sit and stand-up, ten metres walk, and TUG test performances improved in the MwM + placebo taping group (p < 0.05). Pain intensity during the tests was also significantly better after intervention in those two groups (p < 0.05). Comparison between the groups showed that the pain intensity during all tests was less and functional test scores were better in sit and stand-up, ten metres walk, and walking down stairs in the MwM + taping group than the MwM + placebo taping group. CONCLUSIONS: MwM accompanied by taping improves pain during functional activities as well as the performance. MwM without taping may also improve pain intensity; however, it may be inadequate in increasing the performance.

[The experience with the early rehabilitation of the children presenting with the vertebral cerebrospinal injury]. / Opyt rannei reabilitatsii detei s pozvonochno-spinnomozgovoi travmoi.

This article was designed to report the experience with the provision of early rehabilitation care to the children suffering from a spinal-cord injury (SCI) that was gained at the Clinical and Research Institute of Urgent Pediatric Surgery and Traumatology. The authors have developed and describe the combined multidisciplinary approach making it possible to promote the recovery of the children presenting with SCI at the first stage of the rehabilitative treatment. They distinguish three basic periods in the early rehabilitation of the children with this condition, defined the main goals of rehabilitation and the role of each specialist in their achievement. The results of the work provided the basis for the development of a stepwise approach for the extension of the rehabilitation measures and the solution of the tasks facing rehabilitation of the patients with vertebral cerebrospinal injuries. The correction of nutritive losses was found to be a most important component of the early stage of the rehabilitation process preceding the full-scale rehabilitative treatment. The role of various technical devices designed for the patients' re-education in functional motor activities, development and acquisition of the sustained self-service skills, enhancement of the patient's mobility, and improvement of his/her quality of life is discussed. The importance of the early beginning of the rehabilitation measures for the children suffering from a vertebral cerebrospinal injury has been confirmed.

Design and construction of a novel low-cost device to provide feedback on manually applied forces.

STUDY DESIGN: Design and evaluation, technical note. OBJECTIVES: To describe the design of a simple, low-cost device for providing feedback of manually applied forces to the cervical spine, and to assess the device against specific design criteria. BACKGROUND: The forces applied during manual therapy may vary by as much as 500% between practitioners. But consistency can be improved in students when they are provided with contemporaneous feedback. The current methods of providing feedback, however, are expensive, complex, and/or preclude their performance in a clinically relevant manner. METHODS: The design of the device was assessed in accordance of the following criteria: (1) ease of use, (2) low cost, (3) minimal interference with technique, (4) ability to provide feedback with suitable accuracy at forces up to 50 N, and (5) no requirement of specialized skills to construct. RESULTS: A device is described that interfaces with standard computers through the sound card and measures force, using thin, low-cost, force-sensing resistors. Evaluated against the design criteria, the device (1) is easy to set-up and use, (2) can be produced for under $30 US dollars, (3) creates minimal interference with performance of a variety of techniques, (4) has limits of agreement from -3.8 to 4.2 N for forces of 5 to 45 N and repeatability coefficients of ± 2.0 N or 12%, and (5) can be constructed without specialized skills or knowledge. CONCLUSION: A device is described that fulfills most of the design criteria for providing feedback on forces for physical therapy students and may have applications in other fields.

Ischemic stroke-induced polyaxonal innervation at the neuromuscular junction is attenuated by robot-assisted mechanical therapy.

Ischemic stroke is a leading cause of disability world-wide. Mounting evidence supports neuromuscular pathology following stroke, yet mechanisms of dysfunction and therapeutic action remain undefined. The objectives of our study were to investigate neuromuscular pathophysiology following ischemic stroke and to evaluate the therapeutic effect of Robot-Assisted Mechanical massage Therapy (RAMT) on neuromuscular junction (NMJ) morphology. Using an ischemic stroke model in male rats, we demonstrated longitudinal losses of muscle contractility and electrophysiological estimates of motor unit number in paretic hindlimb muscles within 21 days of stroke. Histological characterization demonstrated striking pre- and postsynaptic alterations at the NMJ. Stroke prompted enlargement of motor axon terminals, acetylcholine receptor (AChR) area, and motor endplate size. Paretic muscle AChRs were also more homogenously distributed across motor endplates, exhibiting fewer clusters and less fragmentation. Most interestingly, NMJs in paretic muscle exhibited increased frequency of polyaxonal innervation. This finding of increased polyaxonal innervation in stroke-affected skeletal muscle suggests that reduction of motor unit number following stroke may be a spurious artifact due to overlapping of motor units rather than losses. Furthermore, we tested the effects of RAMT - which we recently showed to improve motor function and protect against subacute myokine disturbance - and found significant attenuation of stroke-induced NMJ alterations. RAMT not only normalized the post-stroke presentation of polyaxonal innervation but also mitigated postsynaptic expansion. These findings confirm complex neuromuscular pathophysiology after stroke, provide mechanistic direction for ongoing research, and inform development of future therapeutic strategies. SIGNIFICANCE: Ischemic stroke is a leading contributor to chronic disability, and there is growing evidence that neuromuscular pathology may contribute to the impact of stroke on physical function. Following ischemic stroke in a rat model, there are progressive declines of motor unit number estimates and muscle contractility. These changes are paralleled by striking pre- and postsynaptic maladaptive changes at the neuromuscular junction, including polyaxonal innervation. When administered to paretic hindlimb muscle, Robot-Assisted Mechanical massage Therapy - previously shown to improve motor function and protect against subacute myokine disturbance - prevents stroke-induced neuromuscular junction alterations. These novel observations provide insight into the neuromuscular response to cerebral ischemia, identify peripheral mechanisms of functional disability, and present a therapeutic rehabilitation strategy with clinical relevance.

The relation between neuromechanical parameters and Ashworth score in stroke patients.

BACKGROUND: Quantifying increased joint resistance into its contributing factors i.e. stiffness and viscosity ("hypertonia") and stretch reflexes ("hyperreflexia") is important in stroke rehabilitation. Existing clinical tests, such as the Ashworth Score, do not permit discrimination between underlying tissue and reflexive (neural) properties. We propose an instrumented identification paradigm for early and tailor made interventions. METHODS: Ramp-and-Hold ankle dorsiflexion rotations of various durations were imposed using a manipulator. A one second rotation over the Range of Motion similar to the Ashworth condition was included. Tissue stiffness and viscosity and reflexive torque were estimated using a nonlinear model and compared to the Ashworth Score of nineteen stroke patients and seven controls. RESULTS: Ankle viscosity moderately increased, stiffness was indifferent and reflexive torque decreased with movement duration. Compared to controls, patients with an Ashworth Score of 1 and 2+ were significantly stiffer and had higher viscosity and patients with an Ashworth Score of 2+ showed higher reflexive torque. For the one second movement, stiffness correlated to Ashworth Score (r2 = 0.51, F = 32.7, p < 0.001) with minor uncorrelated reflexive torque. Reflexive torque correlated to Ashworth Score at shorter movement durations (r2 = 0.25, F = 11, p = 0.002). CONCLUSION: Stroke patients were distinguished from controls by tissue stiffness and viscosity and to a lesser extent by reflexive torque from the soleus muscle. These parameters were also sensitive to discriminate patients, clinically graded by the Ashworth Score. Movement duration affected viscosity and reflexive torque which are clinically relevant parameters. Full evaluation of pathological joint resistance therefore requires instrumented tests at various movement conditions.

Adhesive capsulitis and dynamic splinting: a controlled, cohort study.

BACKGROUND: Adhesive Capsulitis (AC) affects patient of all ages, and stretching protocols are commonly prescribed for this condition. Dynamic splinting has been shown effective in contracture reduction from pathologies including Trismus to plantar fasciitis. The purpose of this study was to examine the efficacy of dynamic splinting on patients with AC. METHODS: This controlled, cohort study, was conducted at four physical therapy, sports medicine clinics in Texas and California. Sixty-two patients diagnosed with Stage II Adhesive Capsulitis were grouped by intervention. The intervention categories were as follows: Group I (Control); Group II (Physical Therapy exclusively with standardized protocols); Group III; (Shoulder Dynasplint system exclusively); Group IV (Combined treatment with Shoulder Dynasplint and standardized Physical Therapy). The duration of this study was 90 days for all groups, and the main outcome measures were change in active, external rotation. RESULTS: Significant difference was found for all treatment groups (p < 0.001) following a one-way ANOVA. The greatest change with the smallest standard deviation was for the combined treatment group IV, (mean change of 29 degrees ). CONCLUSION: The difference for the combined treatment group was attributed to patients' receiving the best PT combined with structured "home therapy" that contributed an additional 90 hours of end-range stretching. This adjunct should be included in the standard of care for adhesive Capsulitis. TRIAL NUMBER: NCT00873158.

Improved Yale Total Tic Severity Score Due to Craniofacial Manipulation With an Oral Appliance.

BACKGROUND: This study evaluated a novel treatment approach using the concept of cranial facial manipulation with an oral appliance, the TicTocStop Tic Guard (TTSTG), also known as the Tic Guard, to determine its safety and efficacy in the treatment of Tourette syndrome (TS) and chronic tic disorders (CTDs). METHODS: A two-center study was undertaken at the University of Tennessee Health Science Center and a facility on Long Island, New York. A total of 77 subjects enrolled between the centers upon referral from local neurologists and via Internet enrollment; 67 subjects started the study, and 58 completed the study. A licensed Cognitive Behavioral Intervention for Tics (CBIT) determined the subjects' Yale Total Tic Severity Score (YTTSS) for tics at enrollment, after 1-week sham appliance, after 1-week Tic Guard, and after 10-weeks Tic Guard. RESULTS: The results showed statistically significant improvement in the YTTSS with both the sham appliance and the Tic Guard with more robust improvement with the Tic Guard. The sham appliance resulted in a 25% overall reduction in tic severity, while the Tic Guard resulted in a 39% overall reduction in tic severity. There were no serious adverse events reported with either device. CONCLUSIONS: This study demonstrated significant reduction in YTTSS using the Tic Guard with no reported serious adverse events. As a result, this device could be considered for inclusion in treatment modalities offered to patients with TS/CTD.

Instrument-Assisted Soft-Tissue Mobilization for the Management of Chronic Plantar Heel Pain: A Pilot Study.

BACKGROUND: The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP). METHODS: Eleven participants with plantar heel pain lasting 6 weeks to 1 year were randomly assigned to one of two groups, with each group receiving up to eight physical therapy visits. Both groups received the same stretching, exercise, and home program, but the experimental group also received IASTM using the Graston technique. Outcome measures of pain and function were recorded at baseline, after final treatment, and 90 days later. Feasibility of a larger study was determined considering recruitment and retention rates, compliance, successful application of the protocol and estimates of the treatment effect. RESULTS: Both groups demonstrated improvements in current pain (pain at time of survey), pain with the first step in the morning, and function after final treatment and at 90-day follow up. Medium-to-large effect sizes between groups were noted, and sample size estimates demonstrated a need for at least 42 participants to realize a group difference. A larger-scale study was determined to be feasible with modifications including a larger sample size and higher recruitment rate. CONCLUSIONS: This pilot study demonstrates that inclusion of IASTM using the Graston technique for CPHP lasting longer than 6 weeks is a feasible intervention warranting further study. Clinically important changes in the IASTM group and moderate-to-large between-group effect sizes suggest that further research is warranted to determine whether these trends are meaningful.

[Research on the stability of teaching robots of rotation-traction manipulation].

OBJECTIVE: To evaluate the stability of teaching robot of rotation-traction manipulation. METHODS: Operators were required to get the hang of rotation-traction manipulation and had clinical experience for over 5 years. The examination and data processing of the ten operators in our research were collected by the teaching robot of rotation-traction manipulation. Traction, pulling force, maximum force, pulling time, rotational amplitude and pitch range were recorded and compared for five times(G1, G2, G3, G4 and G5). The qualification rates were analyzed to evaluate the stability of teaching robot of rotation-traction manipulation. RESULTS: Nonconforming items were found in G1 and G2, for instance, pulling force(P=0.074), maximum force(P=0.264) and rotational amplitude (P=0.531). There was no statistically difference. None nonconforming item was found in G3, G4 and G5. All data were processed by SPSS and One-way ANOVA was used to analysis. Pulling force was found statistically different in G1, compared with G4 and G5(P=0.015, P=0.006). Maximum force was found statistically different in G1, compared with G4 and G5 (P=0.021, P=0.012). None differences were found in other comparisons (P>0.05). CONCLUSIONS: The teaching robot of rotation-traction manipulation used in our research could provide objective and quantitative indices and was considered to be an effective tool of assessing the rotation-traction manipulation.

[The optimization of restoration approaches of advanced hand activity using the sensorial glove and the mCIMT method]. / Optimizatsiia podkhodov k vosstanovleniiu tonkoi motoriki kisti s ispol'zovaniem sensornoi perchatki i metoda mCIMT.

AIM: To reason the choice of methods of restoration of advanced hand activity depending on severity of motor disturbance in the top extremity. MATERIAL AND METHODS: Eighty-eight patients were randomized into 3 groups: 1) the mCIMT group, 2) the 'touch glove' group, 3) the control group. For assessment of physical activity of the top extremity Fugl-Meyer Assessment Upper Extremity, Nine-Hole Peg Test, Motor Assessment Scale were used. Assessment of non-use phenomenon was carried out with the Motor Activity Log scale. RESULTS AND CONCLUSION: At a stage of severe motor dysfunction, there was a restoration of proximal departments of a hand in all groups, neither method was superior to the other. In case of moderate severity of motor deficiency of the upper extremity the most effective was the method based on the principle of biological feedback - 'a touch glove'. In the group with mild severity of motor dysfunction, the best recovery was achieved in the mCIMT group.

Robot-guided ankle sensorimotor rehabilitation of patients with multiple sclerosis.

BACKGROUND: People with multiple sclerosis (MS) often develop symptoms including muscle weakness, spasticity, imbalance, and sensory loss in the lower limbs, especially at the ankle, which result in impaired balance and locomotion and increased risk of falls. Rehabilitation strategies that improve ankle function may improve mobility and safety of ambulation in patients with MS. This pilot study investigated effectiveness of a robot-guided ankle passive-active movement training in reducing motor and sensory impairments and improving balance and gait functions. METHODS: Seven patients with MS participated in combined passive stretching and active movement training using an ankle rehabilitation robot. Six of the patients finished robotic training 3 sessions per week over 6 weeks for a total of 18 sessions. Biomechanical and clinical outcome evaluations were done before and after the 6-week treatment, and at a follow-up six weeks afterwards. RESULTS: After six-week ankle sensorimotor training, there were increases in active range of motion in dorsiflexion, dorsiflexor and plantar flexor muscle strength, and balance and locomotion (p<0.05). Proprioception acuity showed a trend of improvement. Improvements in four biomechanical outcome measures and two of the clinical outcome measures were maintained at the 6-week follow-up. The study showed the six-week training duration was appropriate to see improvement of range of motion and strength for MS patients with ankle impairment. CONCLUSION: Robot-guided ankle training is potentially a useful therapeutic intervention to improve mobility in patients with MS.

Variability of force magnitude and force duration in manual and instrument-based manipulation techniques.

OBJECTIVE: The goal of this study was to compare the variation of manipulative forces produced by instruments and a manual technique. METHODS: Four operators (2 experts and 2 novices) used 4 different mechanical instruments to apply force to a uniaxial load cell. A different group of 2 expert and 2 novice operators used a traditional manual technique to apply force to a sensor mat. Two primary outcome variables were obtained from each sensor system: peak-to-peak force magnitude (N) and peak-to-peak force duration (millisecond). Multiple analyses were performed to determine the absolute differences and variation in each variable. RESULTS: Force-producing instrumentation exhibited less variation in absolute force and force duration compared to manual techniques. However, the same instrument in the hands of different operators often produced significantly different values of absolute force and force duration. Although absolute values of force magnitude generally differed between operators, intraoperator variation was equal for instruments and the manual technique. Conversely, for force duration, significant differences in interoperator variability were observed for the manual technique and for one of the instruments. CONCLUSIONS: Force-producing instruments reduce absolute variation in force magnitude and duration. However, this reduction does not eliminate significant differences in absolute force parameters observed to occur between some operators using the same instrument. Given these observations, claims of instrument superiority that do not account for interoperator variability should be considered with caution.

Choice of Human-Computer Interaction Mode in Stroke Rehabilitation.

BACKGROUND AND OBJECTIVE: Advances in technology are providing new forms of human-computer interaction. The current study examined one form of human-computer interaction, augmented reality (AR), whereby subjects train in the real-world workspace with virtual objects projected by the computer. Motor performances were compared with those obtained while subjects used a traditional human-computer interaction, that is, a personal computer (PC) with a mouse. METHODS: Patients used goal-directed arm movements to play AR and PC versions of the Fruit Ninja video game. The 2 versions required the same arm movements to control the game but had different cognitive demands. With AR, the game was projected onto the desktop, where subjects viewed the game plus their arm movements simultaneously, in the same visual coordinate space. In the PC version, subjects used the same arm movements but viewed the game by looking up at a computer monitor. RESULTS: Among 18 patients with chronic hemiparesis after stroke, the AR game was associated with 21% higher game scores (P = .0001), 19% faster reaching times (P = .0001), and 15% less movement variability (P = .0068), as compared to the PC game. Correlations between game score and arm motor status were stronger with the AR version. CONCLUSIONS: Motor performances during the AR game were superior to those during the PC game. This result is due in part to the greater cognitive demands imposed by the PC game, a feature problematic for some patients but clinically useful for others. Mode of human-computer interface influences rehabilitation therapy demands and can be individualized for patients.

A portable vibrator for muscle performance enhancement by means of direct muscle tendon stimulation.

Combining vibration stimulation with conventional resistance training has gained in popularity. However, no portable vibrator capable of directly stimulating muscle tendon appears to feature in the literature. The aim of this study was the development of such a unit. The unit developed makes use of a rotating eccentric mass system to produce desired amplitude and frequency range capable of investigating the diverse vibration characteristics used in previous research studies. The effects of strapping force, joint angle and day-to-day repeatability on these vibration characteristics were investigated. In addition, muscle electromyography (EMG) activity was subsequently used to identify the optimum vibration amplitude and frequency. Finally, the repeatability of these EMG responses and effect of joint angle were examined. The unit was able to produce desired vibration characteristics (amplitude: 0.2-2 mm; frequency: 30-200 Hz). Test day, strapping force and joint angle had no significant effect on these characteristics (p>0.05). Both amplitudes (0.5 and 1.2 mm) and all three frequencies (30, 65 and 100 Hz) tested, significantly enhanced EMG activity (p<0.05), with 1.2 mm and both 65 and 100 Hz resulting in significantly greater enhancements (p<0.05). Joint angle had no significant effect on these EMG results (p>0.05). The day-to-day repeatability of EMG response was shown to be high (r=0.76-0.90).

[The design of an electromyogram-guided treatment instrument].

The text introduces an electromyogram-guided treatment instrument with simple operation and lower cost, and it is easy to find the lesion muscle. Its clinical tests have shown a satisfying result.

The mechanical effect of kinesiology tape on rounded shoulder posture in seated male workers: a single-blinded randomized controlled pilot study.

STUDY DESIGN: Single-blinded randomized controlled pilot study. OBJECTIVES: To examine the changes in pectoralis minor length (PML), the supine measurement of rounded shoulder posture (RSP), and the total scapular distance (TSD) in seated male workers with RSP, after rounded-shoulder-taping (RST) using kinesiology tape with (experimental taping) and without stretch (placebo taping). BACKGROUND: RSP, a postural impairment, is a known cause of upper quarter pain. METHODS: Fourteen men with RSP, who worked for at least 7 h/d in a seated position, were selected for RST, with the shoulders randomly assigned to two kinesiology taping methods: (1) with 35-40% stretch of its original length; and (2) without stretch. The PML, supine measurements of RSP, and TSD, before and after kinesiology taping, with and without stretch, were assessed. RESULTS: Kinesiology taping with stretch significantly increased the PML and significantly decreased the supine measurement of RSP and TSD; kinesiology taping without stretch did not increase the PML significantly and did not decrease the supine measurement of RSP and TSD. CONCLUSION: RST using kinesiology tape with stretch produces immediate mechanical correction of RSP in seated male workers.

A cable-driven wrist robotic rehabilitator using a novel torque-field controller for human motion training.

Rehabilitation technologies have great potentials in assisted motion training for stroke patients. Considering that wrist motion plays an important role in arm dexterous manipulation of activities of daily living, this paper focuses on developing a cable-driven wrist robotic rehabilitator (CDWRR) for motion training or assistance to subjects with motor disabilities. The CDWRR utilizes the wrist skeletal joints and arm segments as the supporting structure and takes advantage of cable-driven parallel design to build the system, which brings the properties of flexibility, low-cost, and low-weight. The controller of the CDWRR is designed typically based on a virtual torque-field, which is to plan "assist-as-needed" torques for the spherical motion of wrist responding to the orientation deviation in wrist motion training. The torque-field controller can be customized to different levels of rehabilitation training requirements by tuning the field parameters. Additionally, a rapidly convergent parameter self-identification algorithm is developed to obtain the uncertain parameters automatically for the floating wearable structure of the CDWRR. Finally, experiments on a healthy subject are carried out to demonstrate the performance of the controller and the feasibility of the CDWRR on wrist motion training or assistance.

Changes in structural integrity are correlated with motor and functional recovery after post-stroke rehabilitation.

PURPOSE: Diffusion tensor imaging (DTI) studies indicate the structural integrity of the ipsilesional corticospinal tract (CST) and the transcallosal motor tract, which are closely linked to stroke recovery. However, the individual contribution of these 2 fibers on different levels of outcomes remains unclear. Here, we used DTI tractography to investigate whether structural changes of the ipsilesional CST and the transcallosal motor tracts associate with motor and functional recovery after stroke rehabilitation. METHODS: Ten participants with post-acute stroke underwent the Fugl-Meyer Assessment (FMA), the Wolf Motor Function Test (WMFT), the Functional Independence Measure (FIM), and DTI before and after bilateral robotic training. RESULTS: All participants had marked improvements in motor performance, functional use of the affected arm, and independence in daily activities. Increased fractional anisotropy (FA) in the ipsilesional CST and the transcallosal motor tracts was noted from pre-treatment to the end of treatment. Participants with higher pre-to-post differences in FA values of the transcallosal motor tracts had greater gains in the WMFT and the FIM scores. A greater improvement on the FMA was coupled with increased FA changes along the ipsilesional CST. CONCLUSIONS: These findings suggest 2 different structural indicators for post-stroke recovery separately at the impairment-based and function-based levels.