Ground reaction force patterns in stroke patients with various degrees of motor recovery determined by plantar dynamic analysis.

BACKGROUND: To study ground reaction force (GRF) patterns in stroke patients with various degrees of motor recovery, using plantar dynamic analysis. METHODS: Forty-three people with hemiplegic stroke and 20 healthy subjects were enrolled in the study. Motor impairment (motor recovery and muscle tone) and plantar dynamic data (GRF patterns, peak pressure, and walking speeds) were analyzed. GRF patterns were categorized into four patterns based on the force magnitude (spatial features) through time (temporal features) of the vertical GRF. Then stroke patients were classified into good (patterns III and IV) and poor groups (patterns I and II). RESULTS: Patients with hemiplegic stroke showed characteristic GRF patterns which could be categorized from bimodal (pattern IV) to pathological shapes (I-III). The peak pressures on the paretic side in the metatarsal and toe areas were reduced in stroke patients compared with those in healthy subjects. Walking speeds were higher in the good group than in the poor group (p < 0.05). The peak pressures on both sides in the metatarsal and midfoot areas were lower in the poor group than in the good group (p < 0.05). GRF patterns were highly correlated with walking speeds (r = 0.92, p < 0.01). GRF patterns and walking speeds were positively correlated with motor recovery of knee movement (r > 0.4, p < 0.01), but not with hip and ankle movement or muscle tone in the lower limb. CONCLUSIONS: GRF patterns, correlated with walking speeds, indicate underlying motor control of hemiplegic or hemiparetic gait. Knee motor control may be the most important factor in determining walking performance. Plantar dynamic analysis could allow clinicians an alternative assessment in detecting gait changes and planning therapeutic strategies in stroke patients.

Enhancement of operational efficiencies for people with high cervical spinal cord injuries using a flexible integrated pointing device apparatus.

OBJECTIVE: To investigate the effectiveness of a universal integrated pointing device apparatus (IPDA), which can integrate numerous commercial pointing devices and can be controlled by various combinations of available movements, for people with cervical spinal cord injury (SCI) who cannot operate standard computer pointing devices. DESIGN: An exploratory quasi-experimental design. All subjects were required to perform specific mouse-operating (continuous-clicking, target-acquisition, drag-and-drop) tasks. People with SCI received clinical assessments and were classified into 2 groups based on pointing device used: group A, who used standard mouse devices, and group B (IPDA combinations), who were unable to use standard mouse devices. The measures of group A and group B were compared. SETTING: Rehabilitation science center of a medical institution. PARTICIPANTS: Thirty-seven people with high cervical SCI and 30 able-bodied subjects. INTERVENTION: The IPDA. MAIN OUTCOME MEASURES: The efficiency of the people with SCI in each mouse-operation task was expressed as a percentage of that for able-bodied subjects (%NL). RESULTS: Group B displayed similar operational efficiency in performing the drag-and-drop tasks ( approximately 30% NL) to group A, although they exhibited worse efficiency than group A in performing the other tasks (P<.05). Operational efficiencies of all tasks had negative relationships with age by using linear regression analysis (adjusted r(2)>.36, P<.001). The use of pointing devices was associated with American Spinal Injury Association Impairment Scale (P<.001), completeness (P<.001), and muscle strength (P<.01), particularly finger flexor muscle strength, but not with neurologic level or muscle tone. CONCLUSIONS: The IPDA could help most people with high cervical SCI who could not use commercial mouse devices to achieve acceptable operational efficiencies. Pointing devices were assigned based on the underlying SCI severity and muscle strength, particularly finger flexor muscle strength.

Critical score of Glasgow Coma Scale for pediatric traumatic brain injury.

The aim of this study is to determine the predictive critical value of the Glasgow Coma Scale for use as a determinant of outcome for children with traumatic brain injuries. A total of 309 children, aged 2-10 years, were enrolled in this study. Each subject underwent the following assessments: Glasgow Coma Scale; clinical data; brain computed tomography; and Glasgow Outcome Scale assessments. The receiver operating characteristic curve indicated that a critical point of the Glasgow Coma Scale set at 5 was most strongly correlated with outcome of pediatric traumatic brain injury. Subarachnoid hemorrhage with brain swelling and edema, subdural, intracerebral hemorrhage, and basal ganglion lesions were associated with severe injury and poor outcome (P < 0.05). However, cortical lesions did not affect injury severity and outcome. In injuries associated with traumatic brain injuries, only chest trauma had a tendency to be associated with poor outcome (P < 0.05). Of the factors analyzed, the score of the Glasgow Coma Scale was the most effective predictor for outcome in pediatric traumatic brain injury. Furthermore, the predictive critical score of the Glasgow Coma Scale should be set at 5 for pediatric traumatic brain injury. The computed tomographic findings also were important in determining injury severity and predicting outcome.

Effect of neuromuscular electrical stimulation on cough capacity and pulmonary function in patients with acute cervical cord injury.

OBJECTIVE: To assess the effectiveness of neuromuscular electrical stimulation (NMES) on cough capacity and prevention of pulmonary complication in patients with acute cervical cord injury. DESIGN: A randomized controlled trial. SUBJECTS: Twenty-six tetraplegic patients with cervical spinal cord injury, 13 in the NMES therapy group and 13 in the control group. METHODS: NMES was applied to the clavicular portion of the pectoralis major and abdominal muscle. Pulmonary function tests were performed before and after therapy, and at 3 months and 6 months follow-up. The pulmonary complications in this 6-month follow-up period were also recorded. RESULTS: After the 4-week therapy, and at 3 months and 6 months follow-up testing, patients in the NMES therapy group displayed significant improvement in their peak expiratory flow, forced expiratory volume in 1 second, forced vital capacity, maximal expiratory pressure and maximal inspiratory pressure, compared with those in the control group (p<0.05). Patients in the NMES therapy group also had fewer pulmonary complications in the follow-up period. CONCLUSION: NMES over the pectoralis and abdominal muscles might improve cough capacity and pulmonary function in cervical spinal cord injury with tetraplegia. This improvement might last for 6 months. With this improvement, pulmonary complications were reduced.

Effects of visual feedback rhythmic weight-shift training on hemiplegic stroke patients.

OBJECTIVE: To assess the balance function of hemiplegic stroke patients and to investigate whether visual feedback rhythmic weight-shift training following acute stroke can decrease falls among patients with hemiplegic stroke. DESIGN: A prospective study, using a Balance Master. SETTING: Hospital-based rehabilitation units. SUBJECTS: Fifty-two hemiplegic stroke patients (28 in the training group and 24 in the control group). INTERVENTIONS: Conventional stroke rehabilitation programme plus visual feedback rhythmic weight-shift training. Training effect was evaluated by assessing the static and dynamic balance performance as well as comparing the occurrence of falls in the training and control groups at six-month follow-up. MAIN MEASURES: Occurrence of falls; static balance in different sensory conditions; and dynamic balance performance, including on-axis velocity and directional control during rhythmic weight-shift. RESULTS: Significant improvement in dynamic balance performance was found in hemiplegic patients in the training group. The improvement was sustained for six months. With regarding to static balance function, no significant improvement was found. At six-month follow-up, 5 of 28 patients (17.8%) in the training group had fallen, compared with 10 of 24 patients (41.7%) in the control group. The occurrence of falls decreased, although not statistically significantly (p=0.059). CONCLUSIONS: Visual feedback rhythmic weight-shift training may improve dynamic balance function for hemiplegic stroke patients. The effects of training may be sustained for six months. The occurrence of falls decreased in the training group, but not statistically significantly.

Leg muscle activation patterns of sit-to-stand movement in stroke patients.

OBJECTIVE: To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers. DESIGN: Subjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared. RESULTS: The mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated. CONCLUSIONS: Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.

Linguistic and gait disturbance in a child with Laurence-Moon-Biedl syndrome: left temporal and parietal lobe hypoplasia.

Laurence-Moon-Biedl syndrome is an autosomal recessive disorder characterized by retinitis pigmentosa, obesity, polydactyly, hypogenitalism, mental retardation, and renal abnormalities. We report the linguistic and gait disorders in a child with Laurence-Moon-Biedl syndrome associated with left temporal and parietal hypoplasia as determined by magnetic resonance imaging. Our patient was mildly mentally retarded, scoring better on the performance subtest than on the verbal subtest. He received serial assessments for developmental, language, speech, and gait functions, before and after rehabilitation, at age 4.5 and 6 yr, respectively. After comprehensive rehabilitation, the boy achieved improvement in speech, language, fine motor, and gait functions. Early comprehensive rehabilitation programs seem beneficial for improving functional development for children with Laurence-Moon-Biedl syndrome.

The relationship of social function with motor and speech functions in children with autism.

BACKGROUND: Autism is a pervasive developmental disorder, characterized by pervasive impairment in several areas of development, including social interactions and communication skills. The purpose of this study was to investigate the development profiles and determine the relationship of social function with motor and speech functions in children with autism. METHODS: We collected the medical records of 32 children with autism. We used the Chinese Children Developmental Inventory (CCDI) to assess eight functional domains including: gross motor (GM), fine motor (FM), expressive language (EL), concept comprehension (CC), social comprehension (SC), self help (SH), personal social (PS), and general development (GD). The children were classified into group A if the PS development quotient (DQ) was equal to or higher than 50%, or they were classified into group B if the PSDQ was lower than 50%. We compared the DQ between the two groups. A value of p < 0.05 was considered statistically significant. RESULTS: The developmental functions, including motor, speech, and self help functions in the autism group with high social function were better than those in the autism group with low social function. The DQs of all developmental function in group A (60-88%) were higher than those in group B (28-57%) (p < 0.01). The gross motor and fine motor functions were better than speech and social function by 20 to 37% in both groups. Correlation analysis among developmental functions showed significant correlation (r=0.46-0.94, p<0.01). Using a stepwise linear regression test, the PS function was highly correlated with SC (r2=0.832, p <0.001). CONCLUSIONS: Autism is a multifaceted and disproportional developmental disorder. Social communication may play the dominant role in determining the social functions in children with autism.

Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery.

OBJECTIVE: Gait patterns vary among stroke patients. This study attempted to discover gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. DESIGN: Data were gathered from 35 stroke patients and 15 healthy subjects. Gait performance and motor recovery were assessed 6 mos after stroke. Stroke patients further were divided into poor and good groups. The walking velocity was correlated with Brunnström's stages, and the temporal stride and motion variables of the two groups were compared. RESULTS: Walking velocity was positively correlated with the Brunnström's stages of the proximal lower limb. The poor group displayed slower walking velocity and shorter single-support time compared with the good group. Both groups displayed low maximum excursion of hip extension and ankle plantarflexion during the stance phase and low maximum excursion of hip and knee flexion and ankle dorsiflexion during the swing phase. Moreover, both groups displayed excessive pelvic tilts during the stance and swing phases. However, the poor group displayed different pelvic motion and timing sequences to each peak joint angle from normal subjects and the good group. Peak hip and knee angles of the affected limb during the stance phase occurred almost simultaneously in this group. CONCLUSIONS: Selective control of the proximal lower limb may be the main determinant of walking velocity. The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.

Correlation of polyelectromyographic patterns and clinical motor manifestations in children with cerebral palsy.

OBJECTIVE: We investigated the correlation between movement patterns, measured by polyelectromyography (PEMG), and clinical motor manifestations in children with cerebral palsy. DESIGN: Subjects included 53 children with spastic cerebral palsy (diplegic [n = 43] and quadriplegic [n = 10] groups) and 18 normal children. All children underwent PEMG assessments, recorded from pairs of flexor/extensor muscles during voluntary movement. We correlated PEMG patterns with clinical motor assessments, including muscle tone, range of motion, and ambulatory and functional capacities in the children with cerebral palsy. RESULTS: Children with cerebral palsy exhibited four distinct PEMG patterns, ranging from partial reciprocal to complete synchrony. Lower PEMG pattern scores were significantly associated with better ambulatory (rho = 0.88, P < 0.01) and functional (rho = 0.78, P < 0.01) capacities. PEMG patterns also had weakly positive relationships with muscle tone (rho > 0.33, P < 0.01) and range of motion of both lower limbs (rho > 0.31, P < 0.01). Most children of spastic diplegia with PEMG patterns II and III had independent ambulatory capacities and mild limitation of functional capacity, whereas most children with pattern of IV and V had no ambulatory abilities and no independent functional capacities (P < 0.01). CONCLUSIONS: These findings suggest that PEMG patterns correlate with clinical motor deficits and may allow us to plan treatment strategies based on underlying motor control in cerebral palsy.

Effects of balance training on hemiplegic stroke patients.

BACKGROUND: The purpose of this study was to evaluate the delayed effects of balance training program on hemiplegic stroke patients. METHODS: A total of 41 ambulatory hemiplegic stroke patients were recruited into this study and randomly assigned into two groups, the control group and trained group. Visual feedback balance training with the SMART Balance Master was used in the trained group. Bruunstrom staging of affected limb scores and Functional Independent Measure (FIM) scores of each patient were recorded. Quantitative balance function was evaluated using the SMART Balance Master. Data were collected before training and 6 months after completing the training program. RESULTS: Significant improvements in dynamic balance function measurements were found for patients in the trained group at 6 months after completing the training program. The ability of self-care and sphincter control also improved for patients in the trained group. On the other hand, no significant differences were found in static balance functions between the trained group and control group at 6 months of follow up. The locomotion and mobility scoring of FIM also revealed no differences between the groups. CONCLUSION: Dynamic balance function of patients in the visual feedback training group had significant improvements when compared with the control group. Activities of daily living (ADL) function in self-care also had significant improvements at 6 months of follow up in the trained group. The results showed that balance training was beneficial for patients after hemiplegic stroke.