Identifying the characteristics of patients with stroke who have difficulty benefiting from gait training with the hybrid assistive limb: a retrospective cohort study.

Robot-assisted gait training is effective for walking independence in stroke rehabilitation, the hybrid assistive limb (HAL) is an example. However, gait training with HAL may not be effective for everyone, and it is not clear who is not expected to benefit. Therefore, we aimed to identify the characteristics of stroke patients who have difficulty gaining benefits from gait training with HAL. We conducted a single-institutional retrospective cohort study. The participants were 82 stroke patients who had received gait training with HAL during hospitalization. The dependent variable was the functional ambulation category (FAC) that a measure of gait independence in stroke patients, and five independent [age, National Institutes of Health Stroke Scale, Brunnstrom recovery stage (BRS), days from stroke onset, and functional independence measure total score (cognitive items)] variables were selected from previous studies and analyzed by logistic regression analysis. We evaluated the validity of logistic regression analysis by using several indicators, such as the area under the curve (AUC), and a confusion matrix. Age, days from stroke onset to HAL initiation, and BRS were identified as factors that significantly influenced walking independence through gait training with HAL. The AUC was 0.86. Furthermore, after building a confusion matrix, the calculated binary accuracy, sensitivity (recall), and specificity were 0.80, 0.80, and 0.81, respectively, indicated high accuracy. Our findings confirmed that older age, greater degree of paralysis, and delayed initiation of HAL-assisted training after stroke onset were associated with increased likelihood of walking dependence upon hospital discharge.

Changes in vestibular-related responses to combined noisy galvanic vestibular stimulation and cerebellar transcranial direct current stimulation.

Vestibular nuclei and cerebellar function comprise vestibular neural networks that control vestibular-related responses. However, the vestibular-related responses to simultaneous stimulation of these regions are unclear. This study aimed to examine whether the combination of noisy galvanic vestibular stimulation (nGVS) and cerebellar transcranial direct current stimulation (ctDCS) using a complex transcranial electrical stimulation device alters vestibular-dominant standing stability and vestibulo-ocular reflex (VOR) function. The center of foot pressure (COP) sway and VOR of participants (28 healthy, young adults) were assessed under four conditions of transcranial electrical stimulation using nGVS and ctDCS. The COP was calculated with the participant standing on a soft-foam surface with eyes closed using a force plate to evaluate body sway. VOR measurements were collected via passive head movements and fixation on a target projected onto the front wall using a video head impulse test (vHIT). VOR gain was calculated in six directions using a semicircular canal structure based on the ratio of eye movement to head movement. The nGVS + ctDCS and nGVS + sham ctDCS conditions decreased COP sway compared to the sham nGVS + ctDCS and sham nGVS + sham ctDCS conditions. No significant differences were observed in the main effect of stimulation or the interaction of stimulation and direction on the vHIT parameters. The results of this study suggest that postural stability may be independently affected by nGVS. Our findings contribute to the basic neurological foundation for the clinical application of neurorehabilitation using transcranial electrical stimulation of the vestibular system.

Clinically significant effects of gait modification on knee pain: A systematic review and meta-analysis.

BACKGROUND: Knee pain is the main symptom of knee osteoarthritis. Walking is effective against knee pain, and some studies have shown that gait modification can also relieve this condition. However, the quality of evidence for the clinically significant effects of gait modification on knee pain has not been examined. OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the level of evidence for the clinically significant effects of gait modification on knee pain and determine if the effects are greater than the minimal clinically important difference (MCID). METHODS: We comprehensively searched electronic databases such as MEDLINE, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. Intervention studies with experimental groups who received gait modification and control groups who did not were evaluated. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the level of evidence. RESULTS: Nine studies met the inclusion criteria. All were included in the systematic review and two in the meta-analysis. Results showed that gait modification have significant effects (p= 0.02), and the quality of evidence was very low. However, several studies have revealed that the effects of gait modification, when used as a foot-focused intervention, were greater than the MCID. CONCLUSIONS: We concluded that there is a lack of high-quality evidence that supports the general efficacy of gait modification. Although based on low-quality evidence, when applied to the foot, it may have clinically significant effects.

Noisy galvanic vestibular stimulation influences head stability in young healthy adults while standing on a moving platform.

BACKGROUND: The ability to stand with eyes closed on a sinusoidal translational moving platform may be affected by spatial orientation owing to vestibular input information. Moreover, changes in the frequency of the moving platform may affect the sensory reweighting through somatosensory and vestibular sensations. However, it is unclear whether noisy galvanic vestibular stimulation (nGVS), which activates vestibular-related brain regions, affects the stability of individuals standing on a platform moving at different frequencies. RESEARCH QUESTION: Do vestibular stimulation by nGVS and changes in the frequency of translationally moving platforms affect the standing stability of individuals? METHODS: Thirty-one healthy young adult participants were provided both sham and nGVS interventions while they maintained a static standing position, with their eyes closed, on an anterior-posterior sinusoidal translation platform. The nGVS was adapted to an optimal intensity below the perceptual threshold (frequency band: 100-640 Hz), and the sham stimulus was adapted to 0 µA. The participants were randomly assessed for postural stability at 0.2, 0.6, and 1.2 Hz moving platform frequencies for 80 s each under both stimulus conditions. Postural stability was calculated as the root mean square (RMS) sway from head accelerations in the anteroposterior (AP) and mediolateral (ML) directions for 50 s between 20 and 70 s during the 80 s period, measured using an inertial sensor placed on the external occipital ridge. RESULTS: nGVS significantly reduced the RMS sway of head acceleration in the AP direction compared with sham stimulation. Furthermore, nGVS significantly reduced RMS sway in the ML direction compared with sham stimulation at a 1.2 Hz moving platform oscillation. SIGNIFICANCE: These findings suggest that postural adjustment by the vestibular system influences head stability on a moving platform at specific sinusoidal translation frequencies, suggesting that nGVS may reduce head sway.

Effects of transcranial electrical stimulation of the right posterior parietal cortex on physical control responses.

The posterior parietal cortex plays an important role in postural stability by adapting to changes in input from the visual, vestibular, and proprioceptive systems. However, little is known regarding whether transcranial electrical stimulation of the posterior parietal cortex affects reactive postural responses. This study aimed to investigate changes in physical control responses to anodal and cathodal transcranial direct current stimulation and transcranial random noise stimulation of the right posterior parietal cortex using a simultaneous inertial measurement unit. The joint movements of the lower limb of 33 healthy volunteers were measured while standing on a soft-foam surface with eyes closed during various stimulation modalities. These modalities included anodal, cathodal transcranial direct current stimulation, and sham stimulation in Experiment 1, and transcranial random noise and sham stimulations in Experiment 2. The results showed that cathodal stimulation significantly decreased the joint angular velocity in the hip rotation, ankle inversion-eversion, and abduction-adduction directions compared to anodal or sham stimulation in Experiment 1. In contrast, there were no significant differences in physical control responses with transcranial random noise stimulation coeducation in Experiment 2. These findings suggest that transcranial electrical stimulation of the right posterior parietal cortex may modulate physical control responses; however, the effect depends on the stimulus modality.

Effects of Diamond Steps Exercises on Balance Improvement in Healthy Young and Older Adults: A Protocol Proposal.

Diamond step (DS) exercises are associated with multiple components of postural control and, thus, have the potential to efficiently improve balance ability. This study aimed to verify whether DS exercises contribute to improving balance ability. This study included 35 healthy young people and 29 older adults. DS exercises were performed continuously for 3 min, four times a week, for 1 month. Balance ability was assessed at baseline and after 1 and 2 months; eight items in total were examined: 30 s chair stand test, functional reach test, standing on one leg with eyes closed, time required for five rounds of DS, left-right DS, Y balance test, open-close stepping test, and finger-to-floor distance. The difficulty, achievement, and lightness/enjoyment of DS exercises were measured after the first practice and 1 month after beginning the exercises as subjective evaluations. Older adults showed improvement in seven of the eight items, with the exception being the one-legged stance with closed eyes. The subjective evaluation showed a decrease in the level of difficulty of DS exercises for older adults. DS exercises may improve balance by effectively utilizing various postural control strategies. These exercises can be effective and easy to implement, given their moderate difficulty level and self-efficacy.

Impact of skin care on body image of aging people: A quasi-randomized pilot trial.

Aim: Support for various activities of daily living is essential for maintaining the health of residents in nursing homes. Although aging people who move to nursing homes often change their skin care habits, how these changes impact aging adults' social and mental well-being remains unclear. This study aimed to evaluate the effects of facial skin care on aging residents' self-body image, self-esteem, well-being, depressive symptoms and social cognitive function by a quasi-randomized controlled pilot trial in Japanese nursing homes. Method: Thirty-seven older adult women living in nursing homes took part in this quasi-randomized controlled pilot trial. Eighteen participants applied a skincare gel-cream to the face twice a day for three months, while 19 participants used no skincare products. Self-body image and psychological measures such as the Cutaneous Body Image Scale (CBIS), the Rosenberg Self-esteem Scale (RSES), Philadelphia Geriatric Center Morale Scale (PGCMS) and Geriatric Depression Scale (GDS) were used in each nursing home to evaluate the pre- and post-treatment scores. In addition, cognitive items of the Functional Independence Measure (FIM) were evaluated as social cognitive function at pre- and post-treatment. Results: There was a significant different change of the Cutaneous Body Image Scale scores (p = 0.045, r = 0.34) after three months between skin care group and control group. Although there were no clear significant differences in other psychological assessments, there was a higher number of them with positive changes in the skin care group compared to the control group. Conclusion: Skin care may help improve cutaneous self-body image and positive emotion in aging female residents of Japanese nursing homes.

Effects of passive interpersonal light touch during walking on postural control responses: An exploratory study.

The effects of passive interpersonal light touch (PILT) on postural stability can be observed through improved postural coordination through haptic feedback from the contact provider to the contact receiver while walking. It is unclear, however, whether PILT affects the contact receiver's detailed physical responses, such as muscle activity, body sway, and joint movements. In this study, surface electromyography and an inertial measurement unit were used simultaneously to explore changes in walking speed and control responses induced by PILT. We evaluated fourteen healthy participants for their walking speed and physical responses under two walking conditions: no-touch (NT) and PILT. As a physical response during walking, we measured muscle activity (rectus femoris, semitendinosus, tibialis anterior, and soleus muscles), body sway (pelvis and neck), and joint angles (direction of hip, knee, and ankle joint movements). In PILT condition, fingertip contact force was measured while the contact provider touched the third level of the recipient's lumbar spine. In comparison with the NT condition, PILT condition increased walking speed and decreased body sway on neck position. There were significant correlations between walking speed and neck sway regarding NT and PILT change values. Passive haptic information to the contact receiver may assist in the smooth shift of the center of gravity position during gait through interpersonal postural coordination. These findings suggest that PILT may provide an efficient and stable gait.

The effects of walking training with poles on walking ability: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: The purpose of this study was to consolidate the level of evidence for the effects of walking training with poles (pole walking; PW) on walking ability using a systematic review and meta-analysis. TYPE: Systematic review and meta-analysis. LITERATURE SURVEY: Databases including PubMed, Cochrane Library, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature databases, and Igaku Chuo Zasshi were searched on June 20, 2021. METHODOLOGY: Data from randomized controlled trials (RCTs) comparing the effects of PW with walking without poles and/or other exercise interventions in disease-specific and aging populations were collected. Data on walking speed, functional mobility, and walking endurance were collected for the meta-analyses. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated from postintervention means and standard deviations. The PEDro scale was used for assessing the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation system was used to determine the quality of evidence. SYNTHESIS: This study included 13 RCTs comprising 750 participants; of these, six RCTs were included in the meta-analysis. The results showed that moderate-quality evidence supports the positive effects of PW on walking speed in patients with Parkinson disease (walking speed: SMD = 0.42, 95% CI = 0.04-0.80). In contrast, PW did not significantly improve functional mobility in patients with Parkinson disease and walking speed in older adults. CONCLUSIONS: There was moderate-quality evidence that PW improved walking speed in patients with Parkinson disease.

Does frequent use of an exoskeletal upper limb robot improve motor function in stroke patients?

PURPOSE: To determine how differences in frequency of the single-joint hybrid assistive limb (HAL-SJ) use affect the improvement of upper limb motor function and activities of daily living (ADL) in stroke patients. MATERIALS AND METHODS: Subacute stroke patients were divided into the high or low frequency of HAL-SJ use groups. The two groups were matched by propensity score, and the degree of changes 30 days after initiating HAL-SJ use was compared. A logistic regression analysis was performed to examine whether frequent use would increase the number of subjects experiencing the efficacy of more than the minimal clinically important difference (MCID) of Fugl-Meyer assessment (FMA). RESULTS: Twenty-five stroke patients were matched by propensity score, and nine pairs were matched. The high-frequency group showed a significantly superior increase to total FMA shoulder, elbow, forearm, and Barthel index compared with the low-frequency group. Logistic regression analysis revealed no significant associations between frequent use and MCID. CONCLUSIONS: The frequency of HAL-SJ use may affect the improvement of motor function and ADL ability of the upper limb with exception of the fingers and wrist. However, the frequency of intervention was not effective enough to further increase the number of subjects with clinically meaningful changes in upper limb motor function.IMPLICATIONS FOR REHABILITATIONThe current study aimed to clarify how differences in the frequency of single-joint hybrid assistive limb (HAL-SJ) use can affect the improvement of upper-limb motor functions and ADL in subacute stroke patients.Our results implied that the frequency of HAL-SJ use may influence the recovery of upper limb function.However, even if HAL-SJ is used frequently, it does not mean that more patients will achieve clinically meaningful recovery.

Effects of Non-Face-to-Face and Noncontact Interventions on Knee Pain and Physical Activity in Older Adults With Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Increased physical activity is an effective treatment for knee osteoarthritis that causes knee pain. However, due to the coronavirus disease 2019, noncontact and non-face-to-face interventions have increased, but the quality of evidence supporting their effectiveness remains unclear. The purpose of the study was to assess the quality of evidence of the effects of non-face-to-face and noncontact interventions on knee pain and physical activity in older adults with knee osteoarthritis. A meta-analysis was conducted to determine the effects of different intervention methods (education and exercise). The Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were systematically searched. Four randomized controlled trials were included in the analysis. The meta-analysis demonstrated that the educational intervention group was significantly effective, although supportive evidence was low quality. Educational intervention may be effective, but the effects need to be confirmed by higher quality clinical trials.

Decrease in medial meniscal extrusion after physical therapy to improve knee pain and range of motion in patients with knee osteoarthritis: A retrospective study.

BACKGROUND: Medial meniscal extrusion (MME) is the medial displacement of the meniscus, which extends beyond the tibial margin. Studies have shown an association between MME and knee pain and that surgical treatment can reduce the extent of MME. Here, we describe the beneficial effects of physical therapy as a feasible conservative treatment for MME. METHODS: Data of 30 patients with knee osteoarthritis who underwent stretching of the semimembranosus tendon and passive range of motion (ROM) exercises twice a week for 8 weeks were retrospectively analyzed. MME was the measured distance between the medial meniscus and the line connecting the medial borders of the femur and tibia using ultrasound. Ultrasound findings of surrounding tissues, including the deep posterior bundle of the medial collateral ligament (dMCL), were recorded. Additionally, knee extension ROM was measured, and inner knee pain when walking was evaluated using a numerical rating scale. RESULTS: There were significant improvements between the baseline and 8 weeks for MME in the non-weight-bearing position (3.6 ± 0.3 mm vs. 3.0 ± 0.4 mm), MME in the weight-bearing position (4.3 ± 0.4 mm vs. 3.8 ± 0.5 mm), ROM (-12.3° ± 4.1° vs. -3.1° ± 3.8°), and knee pain (7.0 ± 0.9 vs. 1.1 ± 1.4) (each p < 0.001). In almost all cases in which the knee extension ROM improved, the dMCL was bulging at the baseline; after 8 weeks, the dMCL was flattened, suggesting ligament tension on ultrasound imaging. CONCLUSION: Stretching of the semimembranosus tendon and passive ROM exercises may reduce the extent of MME in patients with knee osteoarthritis. The ultrasound findings suggest that improvement in knee extension ROM may have led to the re-acquisition of MCL tension, which may have influenced MME reduction. Therefore, physical therapy may be a feasible conservative treatment for the reduction of MME.

Unilateral cathodal transcranial direct current stimulation over the parietal area modulates postural control depending with eyes open and closed.

OBJECTIVE: Cathodal transcranial direct current stimulation (C-tDCS) is generally assumed to inhibit cortical excitability. The parietal cortex contributes to multisensory information processing in the postural control system, and this processing is proposed to be different between the right and left hemispheres and sensory modality. However, previous studies did not clarify whether the effects of unilateral C-tDCS of the parietal cortex on the postural control system differ depending on the hemisphere. We investigated the changes in static postural stability after unilateral C-tDCS of the parietal cortex. METHODS: Ten healthy right-handed participants were recruited for right- and left-hemisphere tDCS and sham stimulation, respectively. The cathodal electrode was placed on either the right or left parietal area, whereas the anodal electrode was placed over the contralateral orbit. tDCS was applied at 1.5 mA for 15 min. We evaluated static standing balance by measuring the sway path length (SPL), mediolateral sway path length (ML-SPL), anteroposterior sway path length (AP-SPL), sway area, and the SPL per unit area (L/A) after 15-minute C-tDCS under eyes open (EO) and closed (EC) conditions. To evaluate the effects of C-tDCS on pre- and post-offline trials, each parameter was compared using two-way repeated-measures analysis of variance (ANOVA) with factors of intervention and time. A post-hoc evaluation was performed using a paired t-test. The effect sizes were evaluated according to standardized size-effect indices of partial eta-squared (ηp2) and Cohen's d. The power analysis was calculated (1-ß). RESULTS: A significant interaction was observed between intervention and time for SPL (F (2, 27) = 4.740, p = 0.017, ηp2 = 0.260), ML-SPL (F (2, 27) = 4.926, p = 0.015, ηp2 = 0.267), and sway area (F (2, 27) = 9.624, p = 0.001, ηp2 = 0.416) in the EO condition. C-tDCS over the right hemisphere significantly increased the SPL (p < 0.01, d = 0.51), ML-SPL (p < 0.01, d = 0.52), and sway area (p < 0.05, d = 0.83) in the EO condition. In contrast, C-tDCS over the left hemisphere significantly increased the L/A in both the EC and EO condition (EO; p < 0.05, d = 0.67, EC; p < 0.05, d = 0.57). CONCLUSION: These results suggest that the right parietal region contributes to static standing balance through chiefly visual information processing during the EO condition. On the other hand, L/A increase during EC and EO by tDCS over the left parietal region depends more on somatosensory information to maintain static standing balance during the EC condition.

The effectiveness of group education in people over 50 years old with knee pain: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: International guidelines recommend educational intervention to treat knee osteoarthritis. However, they do not specify the type of intervention and the effectiveness of group educational intervention for knee pain is unclear. OBJECTIVES: We aimed to examine the effectiveness of group educational interventions for people over 50 years old with knee pain compared with a control group. DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). METHOD: We searched Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature and screened for RCTs involving participants over 50 years old that reported the effects of group education on knee pain. We performed meta-analyses and evaluated the methodological quality and evidence quality using the Physiotherapy Evidence Database scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS: The search retrieved 1,177 studies. Seven RCTs were ultimately included, four of which were subjected to meta-analysis, showing standardized mean differences of -0.22 (95% confidence interval [CI]: -0.42 to -0.02, n = 423; I2 = 0% GRADE: low). All studies included in the meta-analysis involved exercise without individualized instruction in addition to group educational intervention. CONCLUSIONS: Group education, when delivered in addition to exercises, significantly reduces knee pain in people over 50 years old.

Predicting the prognosis of unilateral spatial neglect using magnetic resonance imaging in patients with stroke: A systematic review.

Accurate prognosis prediction of unilateral spatial neglect (USN) is clinically important for identifying patients with potentially poor recovery who require more intensive rehabilitation and early interdisciplinary support for residual disabilities. Magnetic resonance imaging (MRI)-based neuroimaging can provide clinicians with high-quality and high-resolution neuroanatomical information from the aspects of neuroanatomy, integrity of the neural tract, and neural functional connectivity. Although the application of MRI is expected beneficial for the prognosis prediction of USN, there is still no systematic review of its usefulness, and it has not been standardized in the field of stroke rehabilitation. Therefore, we conducted this systematic review to consolidate evidence on the usefulness of MRI in predicting the prognosis of USN in patients with stroke. We comprehensively searched the Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature electronic databases. We identified 6 longitudinal studies that investigated the relationship between MRI-based neuroimaging findings and subsequent recovery of USN through comprehensive database search. All included studies showed the usefulness of MRI-based findings in predicting the prognosis of USN. The findings of this systematic review highlight the importance of a detailed evaluation of affected neural tracts considering with the differences between the USN subtypes, rather than a broad/undetailed classification of the location, for accurate prognosis prediction of USN in patients with stroke. This is the first report to consolidate evidence on the usefulness of MRI in terms of intra- and interhemispheric neural connection in predicting the prognosis of USN in patients with stroke.

Effects of Noisy Galvanic Vestibular Stimulation on the Muscle Activity and Joint Movements in Different Standing Postures Conditions.

Objective: Noisy galvanic vestibular stimulation (nGVS) is an effective method for stabilizing posture; however, little is known regarding the detailed muscle activity and joint movement in the standing posture. This study aimed to clarify the changes in the lower limb muscle activity and joint angular velocity by nGVS intervention using the simultaneous assessment method of inertial measurement units and surface electromyography (EMG). Methods: Seventeen healthy participants were assessed for their physical responses under four conditions (standing on a firm surface with eyes-open/eyes-closed, and a foam surface with eyes-open/eyes-closed) without stimulation (baseline) and with stimulation (sham or nGVS). Noise stimuli were applied for 30 s at a level below the perceptual threshold. The body control response was evaluated using EMG activity and angular velocity of the lower limbs. Result: Regarding the change from baseline for each parameter, there was a significant interactive effect of EMG activity in the muscle type × intervention and EMG activity and angular velocity in the condition × intervention. Post hoc analysis revealed that the angular velocity was significantly decreased in the abduction-adduction direction in the standing on a foam surface with eyes-closed condition compared to that with eyes-open in the nGVS intervention. Conclusion: Our results suggest that nGVS altered physical responses in different standing postural conditions. The present study is exploratory and therefore the evidence should be investigated in future studies specifically target those muscle activities and joint motion parameters.

Clinical Prediction Rule for Identifying the Stroke Patients who will Obtain Clinically Important Improvement of Upper Limb Motor Function by Robot-Assisted Upper Limb.

BACKGROUND: The number of studies on the characteristics of patients with stroke who would benefit from robot-assisted upper limb rehabilitation is limited, and there are no clear criteria for determining which individuals should receive such treatment. The current study aimed to develop a clinical prediction rule using machine learning to identify the characteristics of patients with stroke who can the achieve minimal clinically important difference of the Fugl-Meyer Upper Extremity Evaluation (FMA-UE) after single-joint hybrid assistive limb (HAL-SJ) rehabilitation. METHODS: This study included 71 patients with subacute stroke who received HAL-SJ rehabilitation. The chi-square automatic interaction detector (CHAID) model was applied to predict improvement in upper limb motor function. Based the analysis using CHAID, age, sex, days from stroke onset to the initiation of HAL-SJ rehabilitation, and upper limb motor and cognitive functions were used as independent variables. Improvement in upper limb motor function was determined based on the minimal clinically important difference of the FMA-UE, which was used as a dependent variable. RESULTS: According to the CHAID model, the FMA-UE score during the initiation of HAL-SJ rehabilitation was the most significant predictive factor for patients who are likely to respond to the intervention. Interestingly, this therapy was more effective in patients with moderate upper limb motor dysfunction and early initiation of HAL-SJ rehabilitation. The accuracy of the CHAID model was 0.89 (95% confidence interval: 0.81-0.96). CONCLUSION: We developed a clinical prediction rule for identifying the characteristics of patients with stroke whose upper limb motor function can improve with HAL-SJ rehabilitation.

Effects of gait training with the Hybrid Assistive Limb on gait ability in stroke patients: A systematic review of randomized controlled trials.

The Hybrid Assistive Limb (HAL) is used in training to improve walking ability for stroke patients; however, the quality of the evidence for its effects has not been fully critiqued to date. This study conducted a systematic review of randomized controlled trials to investigate the effectiveness of post-stroke gait training with the HAL. PubMed, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for randomized controlled clinical trials evaluating the effect of HAL on gait training in stroke patients, published from the inception of each database until March 2021. Two authors screened the titles and abstracts of articles returned in the initial search and reviewed the full text of articles that met the selection criteria. The risk of bias was assessed using the PEDro scale. Of 273 articles retrieved from the databases, three met all inclusion criteria. One study showed that gait training using HAL improves independence in walking; however, the quality of this study was rated as 4 (medium quality). Other studies did not show improvement with HAL in walking independence. This review did not provide strong evidence to support the effectiveness of HAL in improving walking ability.

Association between generalized joint laxity and knee joint movement in female university students.

[Purpose] This study investigated the association between generalized joint laxity and knee joint movement in female university students. [Participants and Methods] The study included 21 female university students. Generalized joint laxity was measured using the Beighton criteria for joint hypermobility. Acceleration and angular velocities of the tibia during knee extension were measured along three axes using a triaxial accelerometer. Sampling data were expressed as root mean squares. The Mann-Whitney U test was used to determine differences in the acceleration and angular velocities along each axis between the generalized joint laxity and non-generalized joint laxity groups. Spearman's rank correlations were used to confirm the association between these parameters. [Results] The rotational angular velocity was greater in the generalized joint laxity than in the non-generalized joint laxity group, and we observed a significant correlation between Beighton scores and the X-axis angular velocity. Furthermore, rotational angular velocity was positively correlated with anterior-posterior acceleration and extension angular velocity. [Conclusion] These findings suggest that rotational angular velocity of the tibia during knee extension is associated with generalized joint laxity in female university students.

Phase-dependent modulation of the vestibular-cerebellar network via combined alternating current stimulation influences human locomotion and posture.

Background: Human locomotion induces rhythmic movements of the trunk and head. Vestibular signaling is relayed to multiple regions in the brainstem and cerebellum, and plays an essential role in maintaining head stability. However, how the vestibular-cerebellar network contributes to the rhythmic locomotor pattern in humans is unclear. Transcranial alternating current stimulation (tACS) has been used to investigate the effects of the task-related network between stimulation regions in a phase-dependent manner. Here, we investigated the relationship between the vestibular system and the cerebellum during walking imagery using combined tACS over the left cerebellum and alternating current galvanic vestibular stimulation (AC-GVS). Methods: In Experiment 1, we tested the effects of AC-GVS alone at around individual gait stride frequencies. In Experiment 2, we then determined the phase-specificity of combined stimulation at the gait frequency. Combined stimulation was applied at in-phase (0° phase lag) or anti-phase (180° phase lag) between the left vestibular and left cerebellar stimulation, and the sham stimulation. We evaluated the AC-GVS-induced periodic postural response during walking imagery or no-imagery using the peak oscillatory power on the angular velocity signals of the head in both experiments. In Experiment 2, we also examined the phase-locking value (PLV) between the periodic postural responses and the left AC-GVS signals to estimate entrainment of the postural response by AC-GVS. Results: AC-GVS alone induced the periodic postural response in the yaw and roll axes, but no interactions with imagery walking were observed in Experiment 1 (p > 0.05). By contrast, combined in-phase stimulation increased yaw motion (0.345 ± 0.23) compared with sham (-0.044 ± 0.19) and anti-phase stimulation (-0.066 ± 0.18) during imaginary walking (in-phase vs. other conditions, imagery: p < 0.05; no-imagery: p ≥ 0.125). Furthermore, there was a positive correlation between the yaw peak power of actual locomotion and in-phase stimulation in the imagery session (imagery: p = 0.041; no-imagery: p = 0.177). Meanwhile, we found no imagery-dependent effects in roll peak power or PLV, although in-phase stimulation enhanced roll motion and PLV in Experiment 2. Conclusion: These findings suggest that combined stimulation can influence vestibular-cerebellar network activity, and modulate postural control and locomotion systems in a temporally sensitive manner. This novel combined tACS/AC-GVS stimulation approach may advance development of therapeutic applications.