Kinematic, electromyographic and isokinetic measurements for the management of shoulder subacromial pain syndrome: A systematic review.

BACKGROUND: Subacromial shoulder pain syndrome is a very common and challenging musculoskeletal disorder. Kinematics, electromyographic muscle activity and isokinetic dynamometry are promising non-invasive movement analysis tools to improve understanding of this condition. No review has combined their results to provide a better understanding of the effects of subacromial pain syndrome on shoulder movement. This systematic review aimed to synthesise the associations between exposure to shoulder pain due to subacromial pain syndromes or subacromial impingement and changes in shoulder movement measures. METHODS: The databases were Scholar google, Pubmed, Science Direct, Scopus and the Cochrane Library. We included studies that observed the association of the presence of subacromial pain syndromes or subacromial impingement with changes in shoulder motion measures. FINDINGS: Seventeen studies with 943 participants were included. The main kinematic change was a lower scapular posterior during abduction in the subacromial pain syndrome group with a "low" level of evidence (standardised mean difference = -0.61, 95% confidence interval [-0.80; -0.43]). The main electromyographic change was an earlier onset of activation of the upper trapezius in the subacromial pain syndrome group, with a "moderate" level of evidence (standardised mean difference = 1.01, 95% confidence interval: [-2.97; 0.96]). The main isokinetic change was a lower peak internal rotator torque in the subacromial pain syndrome group, with a 'low' level of evidence (standardised mean difference = -0.41, 95% confidence interval: [-0.53; -0.29]). INTERPRETATION: The variables measured during movement are associated with subacromial pain syndrome or subacromial impingement syndrome. Consistency between the results supports the importance of scapula biomechanics measurements in these conditions.

Cognitive-behavioral therapy and urge urinary incontinence in women. A systematic review.

INTRODUCTION AND HYPOTHESIS: UUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave. METHODS: We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria. RESULTS: Twelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting. CONCLUSION: Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs.

Ethical Issues Linked to the Development of Telerehabilitation: a Qualitative Study.

While telerehabilitation (TR) makes it possible to respond to many significant health system problems, TR still gives rise to debates, particularly concerning ethical issues. This qualitative study collected the opinions of stakeholders with varied profiles. A guided interview focused on discerning strategies that might foster the ethical deployment of TR. Such strategies were found to be linked to the decision-making of the public authorities, the role of scientific and professional bodies, the training of health professionals, and the management of patient information. Ethical issues relating to the development of TR included universal accessibility, patients' free choice, respect of privacy, and professional confidentiality. The ethical development of TR can be fostered by the provision of information to stakeholders as well as reminding practitioners of the ethical framework that regulates medical practice.

Effect of yoga on health-related quality of life in central nervous system disorders: A systematic review.

OBJECTIVE: Investigate the effect of yoga on health-related quality of life (HRQoL) in patients with central nervous system disorders. METHODS: A systematic search was conducted on the PubMed-NCBI, EBSCO Host, Cochrane Library, Scopus and ScienceDirect databases until 05 April 2021. Only randomized control trials published in English or French were included and had to compare yoga to another intervention group or a control group. They also had to clearly measure HRQoL. Methodological quality was assessed with the revised Cochrane risk-of-bias tool for randomized trials and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS: Sixteen studies were found, including six for multiple sclerosis, five for Parkinson's disease, two for stroke, one for dementia, one for epilepsy and one for brain tumour. Only 12 studies performed between-group statistics and 8 found a significant difference between groups after treatment. When yoga was compared to no intervention, the results were generally in favour of the yoga group, but when yoga was compared to another intervention programme, there was generally no significant difference between groups. There were many different HRQoL questionnaires, even within the same disease, which reduces the comparability of studies. CONCLUSIONS: With low to moderate quality of the evidence, yoga seems effective to improve HRQoL in people with Parkinson's disease. For multiple sclerosis, stroke, dementia, epilepsy and brain tumour, the quality of the evidence is still insufficient to conclude of the effectiveness of yoga.

Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial.

BACKGROUND: Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF). OBJECTIVE: This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains. METHODS: We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n=22, and RAT, n=23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction. RESULTS: In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P=0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P=0.02) and patient social participation (Stroke Impact Scale +18%; P=0.01). Participants' abilities to perform manual activities and activities of daily living improved similarly in both groups. CONCLUSION: For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.

Effect of the neuro-orthopedic surgery for spastic equinovarus foot after stroke: a prospective longitudinal study based on a goal-centered approach.

BACKGROUND: Neuro-orthopedic surgery is recognized as an effective treatment to improve walking capacity in case of spastic equinovarus foot. However, the effect of surgery on the 3 domains of the International Classification of Functioning, Disability and Health (ICF) has never been studied. AIM: The aim of this study was to assess the efficacy of the neuro-orthopedic surgery for spastic equinovarus foot after stroke based on a goal-centered approach and on the 3 domains of the International Classification of Functioning, Disability and Health (ICF). DESIGN: Prospective, single blind, case-series, intervention study (before-after trial) with a 1-year follow-up. SETTING: University Hospital of Mont-Godinne. POPULATION: Eighteen hemiplegic patients with spastic equinovarus foot. METHODS: A selective tibial neurotomy and/or an Achille tendon lengthening, and/or a tibialis anterior tendon transfer were performed to correct a disabling SEF. The primary outcome measure was the goal attainment scale. The secondary outcome measures included body function and structure (spasticity, strength, range of motion, pain, gait speed, ankle kinematics), activities (walking aids, functional ambulation category, functional walking category, ABILOCO) and social participation and quality of life (Satispart-Stroke, SF-36) assessment before and 2 months and 1 year after surgery. RESULTS: An increase in the goal attainment scale score, in the body function and activity/participation domains of the ICF, a decrease in triceps spasticity and pain, an increase in ankle range of motion and gait speed, an improvement in equinus and a reduction in walking aids were observed. CONCLUSIONS: This study confirms the efficacy of the neuro-orthopedic surgical treatment of spastic equinovarus foot after stroke to improve walking capacities and to achieve personal goals in the body function and activity/participation domains of the ICF. CLINICAL REHABILITATION IMPACT: In case of post-stroke spastic foot, a personalized neuro-orthopedic surgical program including neurotomy, tendon lengthening and/or transfer improves patient-centered goals in the different domains of the ICF.

Effectiveness of a single session of dual-transcranial direct current stimulation in combination with upper limb robotic-assisted rehabilitation in chronic stroke patients: a randomized, double-blind, cross-over study.

The impact of transcranial direct current stimulation (tDCS) is controversial in the neurorehabilitation literature. It has been suggested that tDCS should be combined with other therapy to improve their efficacy. To assess the effectiveness of a single session of upper limb robotic-assisted therapy (RAT) combined with real or sham-tDCS in chronic stroke patients. Twenty-one hemiparetic chronic stroke patients were included in a randomized, controlled, cross-over double-blind study. Each patient underwent two sessions 7 days apart in a randomized order: (a) 20 min of real dual-tDCS associated with RAT (REAL+RAT) and (b) 20 min of sham dual-tDCS associated with RAT (SHAM+RAT). Patient dexterity (Box and Block and Purdue Pegboard tests) and upper limb kinematics were evaluated before and just after each intervention. The assistance provided by the robot during the intervention was also recorded. Gross manual dexterity (1.8±0.7 blocks, P=0.008) and straightness of movement (0.01±0.03, P<0.05) improved slightly after REAL+RAT compared with before the intervention. There was no improvement after SHAM+RAT. The post-hoc analyses did not indicate any difference between interventions: REAL+RAT and SHAM+RAT (P>0.05). The assistance provided by the robot was similar during both interventions (P>0.05). The results showed a slight improvement in hand dexterity and arm movement after the REAL+RAT tDCS intervention. The observed effect after a single session was small and not clinically relevant. Repetitive sessions could increase the benefits of this combined approach.

Does observation of a disabled child's action moderate action execution? Implication for the use of Action Observation Therapy for patient rehabilitation.

BACKGROUND: Research investigating action observation-execution priming has mainly manipulated congruent versus incongruent action, and aspects of action expertise/capability. More specifically, the literature suggests enhanced performance priming following action observation by actors closely matched to participant expertise. The aim of the present study was to extend the understanding of action expertise effects by investigating action priming in healthy participants after observing a mild hemiparetic child actor versus a neurologically healthy child actor. METHODS: 16 healthy right-handed children, aged 6-13 years were tested. Several motor assessments were performed, including gross and fine manual motor ability, and upper limb kinematics measured using a precise robotic device. A cross-over design consisted in two experimental conditions (observing actions performed by a child with hemiparesis versus observing actions performed by a healthy child) and a pre-observation double baseline control condition, with the data analyzed using repeated measures ANOVA. RESULTS: Relative to baseline, both types of action observation conditions enhanced fine manual dexterity, but observing the hemiparetic child enhanced gross manual dexterity and upper limb velocity kinematics relative to observing actions performed by a healthy child. No effects were shown on measures of smoothness and accuracy. DISCUSSION: Contradictorily to hypotheses discussed in the literature, results here showed evidence of enhanced action execution when healthy children observed hemiparetic compared to healthy child actions. These results are discussed in terms of how patient compared to healthy actors may be useful for clinical action observation priming therapy.

Assessment of upper limb spasticity in stroke patients using the robotic device REAplan.

OBJECTIVE:  To assess the capacity of the robotic device REAplan to measure overall upper limb peak resistance force, as a reflection of upper limb spasticity. METHODS:  Twelve patients with chronic stroke presenting upper limb spasticity were recruited to the study. Patients underwent musculocutaneous motor nerve block to reduce the spasticity of elbow flexor muscles. Each patient was assessed before and after the motor nerve block. Overall the REAplan measured upper limb resistance force. The robot passively mobilized the patient's upper limb at various velocities (10, 20, 30, 40 and 50 cm/s) in a back-and-forth trajectory (30 cm). The peak resistance force was analysed for each forward movement. Ten movements were performed and averaged at each velocity condition. RESULTS: The overall upper limb resistance force increased proportionally to the mobilization velocity (p< 0.001). Resistance force decreased after the motor nerve block at 40 and 50 cm/s (p < 0.05). Overall upper limb resistance force results showed excellent correlation with the Modified Ashworth Scale for elbow flexor muscles, for each velocity condition equal or higher than 30 cm/s (ρ >0.6). CONCLUSION:  This study proposes a new, valid, reliable and sensitive protocol to quantify upper limb resistance force using the REAplan, as a reflection of upper limb spasticity.

Age Effects on Upper Limb Kinematics Assessed by the REAplan Robot in Healthy Subjects Aged 3 to 93 Years.

Kinematics is recommended for the quantitative assessment of upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish normative values in healthy subjects. Three hundred and seventy healthy subjects, aged 3-93 years, participated in the study. They performed two unidirectional and two geometrical tasks ten consecutive times with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-six kinematic indices were computed for the four tasks. For the four tasks, nineteen of the computed kinematic indices showed an age effect. Seventeen indices (the accuracy, speed and smoothness indices and the reproducibility of the accuracy, speed and smoothness) improved in young subjects aged 3-30 years, showed stabilization in adults aged 30-60 years and declined in elderly subjects aged 60-93 years. Additionally, for both geometrical tasks, the speed index exhibited a decrease throughout life. Finally, a principal component analysis provided the relations between the kinematic indices, tasks and subjects' age. This study is the first to assess age effects on upper limb kinematics and establish normative values in subjects aged 3-93 years.

Age Effects on Upper Limb Kinematics Assessed by the REAplan Robot in Healthy School-Aged Children.

The use of kinematics is recommended to quantitatively evaluate upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish norms in healthy children. Ninety-three healthy children, aged 3-12 years, participated in this study. Twenty-eight kinematic indices were computed from four tasks. Each task was performed with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-four of the 28 indices showed an improvement during childhood. Indeed, older children showed better upper limb movements. This study was the first to use a robotic device to show the age effects on upper limb kinematics and establish norms in healthy children.

Upper limb robot-assisted therapy in cerebral palsy: a single-blind randomized controlled trial.

BACKGROUND: Several pilot studies have evoked interest in robot-assisted therapy (RAT) in children with cerebral palsy (CP). OBJECTIVE: To assess the effectiveness of RAT in children with CP through a single-blind randomized controlled trial. PATIENTS AND METHODS: Sixteen children with CP were randomized into 2 groups. Eight children performed 5 conventional therapy sessions per week over 8 weeks (control group). Eight children completed 3 conventional therapy sessions and 2 robot-assisted sessions per week over 8 weeks (robotic group). For both groups, each therapy session lasted 45 minutes. Throughout each RAT session, the patient attempted to reach several targets consecutively with the REAPlan. The REAPlan is a distal effector robot that allows for displacements of the upper limb in the horizontal plane. A blinded assessment was performed before and after the intervention with respect to the International Classification of Functioning framework: body structure and function (upper limb kinematics, Box and Block test, Quality of Upper Extremity Skills Test, strength, and spasticity), activities (Abilhand-Kids, Pediatric Evaluation of Disability Inventory), and participation (Life Habits). RESULTS: During each RAT session, patients performed 744 movements on average with the REAPlan. Among the variables assessed, the smoothness of movement (P < .01) and manual dexterity assessed by the Box and Block test (P = .04) improved significantly more in the robotic group than in the control group. CONCLUSIONS: This single-blind randomized controlled trial provides the first evidence that RAT is effective in children with CP. Future studies should investigate the long-term effects of this therapy.

Use of kinematic algorithms to distinguish people with chronic non-specific low back pain from asymptomatic subjects: a validation study.

OBJECTIVE: To determine whether kinematic algorithms can distinguish subjects with chronic non-specific low back pain from asymptomatic subjects and subjects simulating low back pain, during trunk motion tasks. DESIGN: Comparative cohort study. SUBJECTS: A total of 90 subjects composed 3 groups; 45 chronic non-specific low back pain patients in the CLBP group; 45 asymptomatic controls people in the asymptomatic controls group. 20/45 subjects from the asymptomatic controls group composed the CLBP simulators group as well. METHOD: During performance of 7 standardized trunk motion tasks 6 spinal segments from the kinematic spine model were recorded by 8 infrared cameras. Two logit scores, for range of motion and speed, were used to investigate differences between the groups. Group allocation based on logit scores was also calculated, allowing the assessment of sensitivity and specificity of the algorithms. RESULTS: For the 90 subjects (pooled data), the logit scores for range of motion and speed demonstrated highly significant differences between groups (p < 0.001). The logit score means and standard deviation (SD) values in the asymptomatic group (n = 45) and chronic non-specific low back pain group (n = 45), respectively, were -1.6 (SD 2.6) and 2.8 (SD 2.8) for range of motion and -2.6 (SD 2.5) and 1.2 (SD 1.9) for speed. The sensitivity and specificity (n = 90) for logit score for range of motion were 0.80/0.82 and for logit score for speed were 0.80/0.87, respectively. CONCLUSION: These results support the validity of using 2 movement algorithms, range of motion and speed, to discriminate asymptomatic subjects from those with low back pain. However, people simulating low back pain cannot be distinguished from those with real low back pain using this method.

Using the robotic device REAplan as a valid, reliable, and sensitive tool to quantify upper limb impairments in stroke patients.

OBJECTIVE: To validate a protocol assessing upper limb kinematics using a planar robot among stroke patients. DESIGN: Prospective cohort study. SUBJECTS: Age-matched healthy subjects (n = 25) and stroke patients (n = 25). METHODS: Various kinematic indices (n = 44) were obtained from 4 tasks performed by subjects with REAplan, a planar end-effector robotic device. The metrological properties of this protocol were studied. RESULTS: In stroke patients, 43 kinematic indices showed moderate to excellent reliability (intraclass correlation coefficients (ICC) range 0.40-0.95; and minimal detectable changes range 9.9-121.1%). In healthy subjects, 25 kinematic indices showed moderate to excellent reliability (ICC range 0.40-0.91) and 3 indices showed a laterality effect (p < 0.05). Many of these indices (27 of 44) were altered in stroke patients in comparison with healthy subjects (p < 0.05). The Box and Block test (manual dexterity) and Upper Limb Sub-score of the Fugl-Meyer Assessment (motor control) showed moderate to good correlations with, respectively, 13 and 4 indices (r > 0.40). Finally, a principal component analysis allowed the elaboration of a short version of the protocol, reducing the number of indices to 5 (i.e. Amplitude, CVstraightness, Speed Metric, CVjerk metric and CVspeed metric). CONCLUSION: This study provides a standardized, valid, reliable and sensitive protocol to quantify upper limb impairments in stroke patients, using a planar robot.

Reliability and validity of a kinematic spine model during active trunk movement in healthy subjects and patients with chronic non-specific low back pain.

OBJECTIVE: To develop a standardized, reliable, valid spine model of active trunk movements that accurately discriminates kinematic patterns of patients with chronic non-specific low back pain from those of healthy subjects. DESIGN: Comparative cohort study. SUBJECTS: Healthy subjects (n = 25) and patients with chronic non-specific low back pain (n = 25) aged 30-65 years. METHODS: Subjects performed 7 trunk movements from a seated position at non-imposed speed during 2 sessions. Nine markers on bony landmarks measured range of motion and speed of 5 spinal segments, recorded by 8 optoelectronic cameras. RESULTS: Both groups showed good-excellent reliability in all movements for range of motion and speed of all spinal segments (intraclass correlation (ICC), 0.70-0.96; standard error of measurement, expressed as a percentage, 19.4-3.3%). The minimal detectable change in the patient group was 16.7-53.7%. Range of motion and speed in all spinal segments for trunk flexion, rotation, and flexion with rotation differed significantly between groups (p < 0.001), with large/very large effect sizes (Cohen's d = 1.2-2). Binary logistic regression yielded sensitivities/specificities of 92%/84% for range of motion and 92%/80% for speed. CONCLUSION: Kinematic variables are valid, reliable measures and can be used clinically to diagnose chronic non-specific low back pain, manage treatment, and as quantitative outcome measures for clinical trial interventions.

A robotic device as a sensitive quantitative tool to assess upper limb impairments in stroke patients: a preliminary prospective cohort study.

OBJECTIVE: To compare kinematic indices in age-matched healthy subjects and stroke patients, by evaluating various tasks performed with a robotic device, and to provide an objective and standardized protocol to assess upper limb impairments in stroke patients. DESIGN: A prospective cohort study. SUBJECTS: Age-matched healthy subjects (n = 10) and stroke patients (n = 10). METHODS: Various kinematic indices were analysed from 3 randomly assigned tasks performed by the affected arm in stroke patients and the dominant arm in healthy subjects. These tasks, composed of large-amplitude, targeted and geometrical movements, were standardized and performed with the ReaPLAN robotic device. RESULTS: For large-amplitude movements, the stroke patients' path lengths were less constant in amplitude, less rectilinear and less smooth than those for healthy subjects (p < 0.001). For the targeted movements, the stroke patients' path lengths were less rectilinear than those of the healthy subjects (p < 0.001). For the geometrical movements, the stroke patients had greater difficulty making the requested shapes compared with the healthy subjects (p < 0.01). CONCLUSION: Our study proposes an objective and standardized protocol to assess stroke patients' upper limbs with any robotic device. We suggest that further randomized controlled trials could use this quantitative tool to assess the efficacy of treatments such as robot-assisted therapy.