Long-term effects of deep-learning digital therapeutics on pain, movement control, and preliminary cost-effectiveness in low back pain: A randomized controlled trial.

Objective: The present study aimed to compare the effects of a deep learning-based digital application with digital application physical therapy (DPT) and those of conventional physical therapy (CPT) on back pain intensity, limited functional ability, lower extremity weakness, radicular symptoms, limited range of motion (ROM), functional movement, quality of life, cost-effectiveness, and postintervention questionnaires for perceived transmission risk of COVID-19 and satisfaction results in 100 participants with low back pain (LBP). Methods: One hundred participants with LBP were randomized into either DPT or CPT groups, three times per week over four weeks. Outcome measures included the (1) Oswestry Disability Index, (2) Quebec Back Pain Disability Scale, (3) Roland-Morris Disability Questionnaire (RMDQ), (4) Numeric Pain Rating Scale, (5) functional movement screen (FMS), (6) short form-12, (7) lower extremity strength, (8) ROM of trunk flexion, extension, and bilateral side bending, (9) questionnaires for perceived transmission risk of COVID-19, (10) preliminary cost-effectiveness, and (11) postintervention satisfaction questionnaire results. The analysis of variance was conducted at p < 0.05. Results: Analysis of variance showed that DPT showed superior effects, compared to CPT on RMDQ, hip extensor strength, transmission risk of COVID-19, as well as satisfaction. Both groups showed significant improvement pre- and postintervention, suggesting that DPT is as effective as CPT, and was superior in preliminary cost-effectiveness and transmission risk of COVID-19. Conclusions: Our results provide novel, promising clinical evidence that DPT was as effective as CPT in improving structural and functional impairment, activity limitation, and participation restriction. Our results highlight the successful incorporation of DPT intervention for clinical outcome measures, lower extremity strength, trunk mobility, ADL improvement, QOL improvement, and FMS in LBP.

Comparison of core stabilization techniques on ultrasound imaging of the diaphragm, and core muscle thickness and external abdominal oblique muscle electromyography activity.

BACKGROUND: To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another. OBJECTIVE: The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude. METHODS: Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P< 0.05. RESULTS: Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P< 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS. CONCLUSIONS: DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.

Comparative effects of community-based family-child-centered care and conventional pediatric rehabilitation for cerebral palsy.

BACKGROUND: While the transdisciplinary-based rehabilitation provided ample evidence on improving impairment (body structure and functions) levels, the therapeutic effects on the international classification of functioning, disability, and health (ICF) domains are unknown in cerebral palsy (CP). OBJECTIVE: To compare the effects of the community-based family-child-centered care (CFC) and conventional pediatric rehabilitation (CPR) on the physical, cognitive, sensory, and social integration domains in children and adolescents with CP. METHODS: Twenty-six participants with CP (mean age = 9.37±5.24, 14 females) were assigned into either CPR or CFC groups. Clinical outcomes included gross motor function measure (GMFM-66), Pediatric Balance Scale (PBS), fine motor area of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Functional Independence Measure (FIM) cognition area, Short Sensory Profile (sSP), COPM, Pediatrics Quality of Life (PedsQL) questionnaire, Short Falls Efficacy Scale (sFES), and Dynamic Postural Instability (DPI). An analysis of variance (ANOVA) and an analysis of covariance (ANCOVA) was conducted at P < 0.05. RESULTS: ANOVA revealed the superior effects of CFC in GMFM-66, PBS, BOT-2, FIM, and PedsQL compared to CPR (P < 0.05). ANCOVA showed the superior effects of CFC in Z-axis of DPI than CPR (P < 0.05). CONCLUSIONS: Our results provide novel, promising clinical evidence that CFC was more effective than CPR at improving impairment, activity, as well as participation levels in participants with CP.

Best core stabilization exercise to facilitate subcortical neuroplasticity: A functional MRI neuroimaging study.

OBJECTIVE: To investigate the effects of conscious (ADIM) and subconscious (DNS) core stabilization exercises on cortical changes in adults with core instability. PARTICIPANTS: Five non-symptomatic participants with core instability. METHODS: A novel core stabilization task switching paradigm was designed to separate cortical or subcortical neural substrates during a series of DNS or ADIM core stabilization tasks. RESULTS: fMRI blood BOLD analysis revealed a distinctive subcortical activation pattern during the performance of the DNS, whereas the cortical motor network was primarily activated during an ADIM. Peak voxel volume values showed significantly greater DNS (11.08 ± 1.51) compared with the ADIM (8.81 ± 0.21) (p= 0.043). CONCLUSION: The ADIM exercise activated the cortical PMC-SMC-SMA motor network, whereas the DNS exercise activated both these same cortical areas and the subcortical cerebellum-BG-thalamus-cingulate cortex network.

Inhibitory effects of instrument-assisted neuromobilization on hyperactive gastrocnemius in a hemiparetic stroke patient.

An instrument-assisted soft tissue mobilization (IASTM) technique has recently been used specifically to inhibit hypertonic muscles and to lengthen muscle fiber shortness. However, it is unknown whether IASTM will show such promising inhibition effects on excessive ankle plantarflexion following stroke. Therefore, the purpose of this study was to use electromyographic (EMG) analysis to determine the ability of IASTM to reduce gastrocnemius (GCM) hypertonicity and concurrently facilitate tibialis anterior (TA) lengthening in a stroke patient. EMG activity on the patient's TA and GCM was measured before and after applying IASTM. After the intervention, the GCM was deactivated by 43%, and TA activity increased by 150%, indicating IASTM-induced inhibition of the overactive GCM. The neuromobilization technique using IASTM showed a promising improvement of neuromuscular imbalance between TA and GCM activations, which can increase gait performance in a stroke case.

Effects of novel tubing gait on neuromuscular imbalance in cerebral palsy.

BACKGROUND: Gait impairments from a neuromuscular imbalance are crucial issues in cerebral palsy. The purpose of our study was to compare the effects of the assistive tubing gait (ATG) and assistive-resistive tubing gait (ARTG) on improving the vasti and hamstring muscle imbalance during the initial contact to mid-stance phases in individuals with spastic diplegic cerebral palsy (CP). METHODS: Fourteen age-matched individuals including seven normal individuals (11.7 years) and seven individuals with CP (12.9 years) were recruited. All participants underwent electromyography (EMG) measurement of the unilateral vasti and hamstring muscle activity during the three gait training conditions of no-tubing gait (NTG), ATG, and ARTG. A statistical one-way repeated-measure analysis of variance (ANOVA) was used to determine differences in the vasti and hamstring activity, the vasti/hamstring ratio, and the knee joint angle across the three gait training conditions for each group. RESULTS: The initial vasti and hamstring muscle imbalance in CP was significantly improved by applying the ARTG compared with the ATG. The vasti/hamstring ratio during the ARTG was compatible with the ratio value obtained from the NTG of normal individuals. The knee joint angle in CP was not improved in this short-term intervention. CONCLUSIONS: The ARTG proportionately increased the vasti activation and reciprocally inhibited the hamstring activity, subsequently improving the neuromuscular imbalance associated with the flexed-knee gait in individuals with spastic diplegic CP.

Immediate effect of Walkbot robotic gait training on neuromechanical knee stiffness in spastic hemiplegia: a case report.

PURPOSE: The purpose of this study was to investigate the immediate effect of Walkbot gait training on knee joint stiffness in an individual with spastic hemiplegia. METHOD: A woman with hemiparetic stroke underwent a 30-minute Walkbot robotic-assisted gait training session. Knee flexion stiffness associated with hamstring spasticity and knee extension torques during the terminal swing phase was determined before and after the intervention using the Walkbot-STIFF measurement system. DESIGN: Descriptive case analysis. RESULTS: Knee joint extension kinematic at the terminal swing phase increased from 2.44° to -0.28°. Knee joint torque increased from 0.26 Nm to 0.32 Nm. The knee flexion stiffness decreased from 0.0083 Nm/degree to 0.0022 Nm/degree following the training. CONCLUSIONS: The Walkbot robotic-assisted locomotor training was effective for reducing knee joint stiffness and improving extensor torque during functional gait. Moreover, the Walkbot-STIFF system was useful for assessing and monitoring spasticity during locomotor training.

Comparative neuroimaging in children with cerebral palsy using fMRI and a novel EEG-based brain mapping during a motor task--a preliminary investigation.

PURPOSE: The purpose of this study was to compare topographical maps using a novel EEG-based brain mapping system with fMRI in normal and children with cerebral palsy (CP) during a grasping motor task. METHOD: A normal child (mean ± SD = 13 ± 0 yrs) and four children with CP (mean ± SD = 10.25 ± 2.86 yrs) were recruited from a local community school and medical center. A novel EEG-based brain mapping system with 30 scalp sites (an extension of the 10-20 system) and a 3T MR scanner were used to observe cortical activation patterns during a grasping motor task. DESIGN: Descriptive analysis. RESULTS: In the EEG brain mapping data, the sensorimotor cortex (SMC) and inferior parietal cortex (IPC) were activated in all of the children. The children with CP showed additional activation areas in the premotor cortex (PMC), superior parietal cortex (SPC), and prefrontal cortex (PFC). In the fMRI brain mapping data, SMC activation was observed in all of the children, and the children with CP showed additional activation areas in the PMC and primary somatosensory cortex (PSC). DISCUSSION: The EEG-based topographical maps were equivalent to the maps obtained from fMRI during the grasping motor task. The results indicate that our novel EEG-based brain mapping system is useful for probing cortical activation patterns in normal children and children with CP.

A novel EEG-based brain mapping to determine cortical activation patterns in normal children and children with cerebral palsy during motor imagery tasks.

PURPOSE: The purpose of this study was to compare EEG topographical maps in normal children and children with cerebral palsy (CP) during motor execution and motor imagery tasks. METHOD: Four normal children and four children with CP (mean age 11.6 years) were recruited from a community medical center. An EEG-based brain mapping system with 30 scalp sites (extended 10--20 system) was used to determine cortical reorganization in the regions of interest (ROIs) during four motor tasks: movement execution (ME), kinesthetic-motor imagery (KMI), observation of movement (OOM), and visual motor imagery (VMI). ROIs included the primary sensorimotor cortex (SMC), premotor cortex (PMC), and supplementary motor area (SMA). DESIGN: Descriptive analysis. RESULTS: Normal children showed increased SMC activation during the ME and KMI aswell as SMC and visual cortex (VC) activation during KMI. Children with CP showed similar activation in the SMC and other motor network areas (PMC, SMA, and VC). During the OOM and VMI tasks, the VC or occipital area were primarily activated in normal children, whereas the VC, SMC, and bilateral auditory areas were activated in children with CP. DISCUSSION: This is the first study demonstrating different neural substrates for motor imagery tasks in normal and children with CP.

The effect of robo-horseback riding therapy on spinal alignment and associated muscle size in MRI for a child with neuromuscular scoliosis: an experimenter-blind study.

PURPOSE: This case study was conducted to highlight the clinical and radiological features of a patient with progressive neuromuscular scoliosis before and after robo-horseback riding therapy (HBRT). DESIGN: A clinical, laboratory, and radiological analysis of a single case. SUBJECT: An 11-year-old child, dignosed right thoracolumbar neuromuscular scoliosis secondary to cerebral palsy. METHOD: The child received a 5-week course of robo-HBRT, comprising of 60-minute periods a day, five times a week. Postural alignment was determined by Cobb's method. A real-time magnetic resonance imaging (MRI) was performed to determine the robo-HBRT-induced changes in cross-sectional area (CSA) of bilateral thoracic (T2) and lumbar (L2) paraspinalis. Clinical tests including the standard Gross Motor Function Measure (GMFM) and manual muscle testing (MMT) with the Lafayette Manual Muscle Tester were used to compare the intervention-related changes in motor performance and power. The surface EMG was also used to examine therapy-induced changes in muscle activity amplitude for bilateral T2 and L2 paraspinalis and rectus abdominis muscles. RESULTS: Clinical motor and strength scores increased after the intervention. Radiographic Cobb's angle, MRI, and electromyographic amplitude data demonstrated notably enhanced spinal alignment and muscle fiber CSA and symmetry, respectively. CONCLUSIONS: This is the first study to provide evidence of the therapeutic efficacy of a novel form of robo-HBRT on motor function and associated structural and motor control improvements, thus suggesting a method of augmenting therapy in neuromuscular scoliosis.