Assessment of Passive Upper Limb Stiffness and Its Function in Post-Stroke Individuals Wearing an Inertial Sensor during the Pendulum Test.

This article proposes the evaluation of the passive movement of the affected elbow during the pendulum test in people with stroke and its correlation with the main clinical scales (Modified Ashworth Scale, Motor Activity Log, and Fulg Meyer). An inertial sensor was attached to the forearm of seven subjects, who then passively flexed and extended the elbow. Joint angles and variables that indicate viscoelastic properties, stiffness (K), damping (B), E1 amp, F1 amp, and relaxation indices were collected. The results show that the FM scale is significantly correlated with the natural frequency (p = 0.024). The MAL amount-of-use score correlates with the natural frequency (p = 0.024). The variables E1 amp, F1 amp, RI, and ERI are not correlated with the clinical scales, but they correlate with each other; the variable E1 amp correlates with F1 amp (p = 0.024) and RI (p = 0.024), while F1 amp correlates with ERI (p = 0.024). There was also a correlation between the natural frequency and K (r = 0.96, p = 0.003). Non-linear results were found for the properties of the elbow joint during the pendulum test, which may be due to the presence of neural and non-neural factors. These results may serve as a reference for future studies if alternative scales do not provide an accurate reflection.

Neuromuscular disorders in women and men with spinal cord injury are associated with changes in muscle and tendon architecture.

OBJECTIVE: The present study aimed to determine the association between neuromuscular function, motor function impairment, and muscle and tendon structures in individuals with spinal cord injury (SCI) compared to a control (non-disabled) population. DESIGN: A cross-sectional study with a control group. SETTING: Center of Adapted Sports Training and Special Physical Education. PARTICIPANTS: Fifteen individuals with SCI and motor function impairments participated in the study. A paired non-disabled group was recruited for comparison. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Muscle (biceps brachii, rectus femoris, vastus lateralis, vastus medialis, and tibialis anterior) and tendon (quadriceps and patellar tendons) structures were assessed by ultrasound imaging (thickness, pennation angle, fascicle length, and echogenicity). Neuromuscular electrophysiological disorders were also assessed using electrodiagnosis techniques (stimulus non-responsivity and chronaxie) in the same muscles. RESULTS: Except for the biceps brachii muscle, muscle thickness, pennation angle, and fascicle length were lower (p < 0.01) while echogenicity and chronaxie were greater (p < 0.01) in SCI participants. The SCI participants had a higher prevalence of neuromuscular electrophysiological disorders for all muscles, except the biceps brachii. CONCLUSION: Neuromuscular disorders occur in association with muscle and tendon maladaptation in individuals with chronic SCI. A higher prevalence of electrophysiological disorders suggests an acquired polyneuromyopathy for muscles with motor function impairment even though the muscle was innerved, in addition to widespread muscle atrophy.

Development of a High-Power Capacity Open Source Electrical Stimulation System to Enhance Research into FES-Assisted Devices: Validation of FES Cycling.

Since the first Cybathlon 2016, when twelve teams competed in the FES bike race, we have witnessed a global effort towards the development of stimulation and control strategies to improve FES-assisted devices, particularly for cycling, as a means to practice a recreational physical activity. As a result, a set of technical notes and research paved the way for many other studies and the potential behind FES-assisted cycling has been consolidated. However, engineering research needs instrumented devices to support novel developments and enable precise assessment. Therefore, some researchers struggle to develop their own FES-assisted devices or find it challenging to implement their instrumentation using commercial devices, which often limits the implementation of advanced control strategies and the possibility to connect different types of sensor. In this regard, we hypothesize that it would be advantageous for some researchers in our community to enjoy access to an entire open-source FES platform that allows different control strategies to be implemented, offers greater adaptability and power capacity than commercial devices, and can be used to assist different functional activities in addition to cycling. Hence, it appears to be of interest to make our proprietary electrical stimulation system an open-source device and to prove its capabilities by addressing all the aspects necessary to implement a FES cycling system. The high-power capacity stimulation device is based on a constant current topology that allows the creation of biphasic electrical pulses with amplitude, width, and frequency up to 150 mA, 1000 µs, and 100 Hz, respectively. A mobile application (Android) was developed to set and modify the stimulation parameters of up to eight stimulation channels. A proportional-integral controller was implemented for cadence tracking with the aim to improve the overall cycling performance. A volunteer with complete paraplegia participated in the functional testing of the system. He was able to cycle indoors for 45 min, accomplish distances of more than 5 km using a passive cycling trainer, and pedal 2400 m overground in 32 min. The results evidenced the capacity of our FES cycling system to be employed as a cycling tool for individuals with spinal cord injury. The methodological strategies used to improve FES efficiency suggest the possibility of maximizing pedaling duration through more advanced control techniques.

Cross-cultural adaptation and reliability of the Brazilian version of the wheelchair skills test-questionnaire 4.3 for manual wheelchair users.

The Wheelchair Skills Test-Questionnaire form for Manual Wheelchairs Operated by Wheelchair Users (WSTQ-M-WCU 4.3) assesses wheelchair skills that may influence users' occupational performance in their daily activities. The purpose of this study was to cross-culturally adapt the WSTQ-M-WCU 4.3 to Brazilian Portuguese and to examine the inter-rater and test-retest reliabilities. This is a methodological study of cross-cultural adaptation and psychometric properties of reliability. The agreement achieved in the cross-cultural adaptation concerning idiomatic, cultural, conceptual and semantic aspects was 100%, 99.2%, 100% and 96.18%, respectively. We analyzed the test-retest and inter-rater reliabilities in a convenience sample of 46 manual wheelchair users using Cronbach's Alpha and Bland-Altman plots. The Brazilian version has excellent internal consistency (α > 0.9) and strong inter-rater reliability (p < .05). This instrument can guide practitioners in training wheelchair skills, thus contributing to the planning of interventions and for evidence-based practice in Assistive Technology.

Pain mapping and health-related conditions in relation to forearm crutch usage: A cross-sectional study.

To explore pain complaints and health-related conditions, verifying if permanent or temporary usage of forearm crutches could be associated with them. We designed a cross-sectional study from a sample who answered a five-month public call. We organized data into five domains: (1) diseases, signs and symptoms; (2) personal factors related to age, sex, marital status, and paid occupation; (3) body structure and functional components defined by body mass index, arterial pressure, mental state, and pain; (4) activities and participation assessed by satisfaction with Assistive Technology; (5) and environmental factors focused on medicines and forearm crutch usage. The sample was geo-referenced by address, and the frequency of the codified health conditions was distributed according to ICD-10's chapters. We recruited three times more permanent than temporary users dealing with chronic and external causes of diseases. Pain mapping suggested different pattern of complaints between permanent and temporary users. Women who were temporary users seemed more likely to be injured because of external causes. Moreover, both users reported intense (31%) and moderate (53%) levels of pain. In contrast, mild pains were only reported by permanent users (16%), suggesting a distinction between acute and chronic pain according to the kind of forearm crutch usage.

Intra- and inter-rater reliability for the measurement of the cross-sectional area of ankle tendons assessed by magnetic resonance imaging.

BACKGROUND: The cross-sectional area (CSA) records make an essential measurement for determining the mechanical properties of tendons, such as stress and strength. However, there is no consensus regarding the best method to record the CSA from different tendons. PURPOSE: To determine intra- and inter-rater reliability for CSA measures from magnetic resonance imaging (MRI) of the following tendons: tibialis anterior; tibialis posterior; fibularis longus and brevis; and Achilles. MATERIAL AND METHODS: We designed an observational study with repeated measures taken from a convenience sample of 20 participants diagnosed with acute or chronic ankle sprain. Two independent raters took three separate records from the CSA of ankle tendon images of each MRI slice. The intra-class correlation coefficient (ICC) and 95% limits of agreement (LoA) defined the quality (associations) and magnitude (differences), respectively, of intra- and inter-rater reliability on the measures plotted by the Bland-Altman method. RESULTS: Data showed very high intra- and inter-rater correlations for measures taken from all tendons analyzed (ICC 0.952-0.999). It also revealed an excellent agreement between raters (0.12%-2.3%), with bias no higher than 2 mm2 and LoA in the range of 4.4-7.9 mm2. The differences between repeated measures recorded from the thinnest tendons (fibularis longus and brevis) revealed the lowest bias and narrowest 95% LoA. CONCLUSION: Reliability for the CSA of ankle tendons measured from MRI taken by independent rates was very high, with the smallest differences between raters observed when the thinnest tendon was analyzed.

A Novel Framework for Quantifying Accuracy and Precision of Event Detection Algorithms in FES-Cycling.

Functional electrical stimulation (FES) is a technique used in rehabilitation, allowing the recreation or facilitation of a movement or function, by electrically inducing the activation of targeted muscles. FES during cycling often uses activation patterns which are based on the crank angle of the pedals. Dynamic changes in their underlying predefined geometrical models (e.g., change in seating position) can lead to desynchronised contractions. Adaptive algorithms with a real-time interpretation of anatomical segments can avoid this and open new possibilities for the automatic design of stimulation patterns. However, their ability to accurately and precisely detect stimulation triggering events has to be evaluated in order to ensure their adaptability to real-case applications in various conditions. In this study, three algorithms (Hilbert, BSgonio, and Gait Cycle Index (GCI) Observer) were evaluated on passive cycling inertial data of six participants with spinal cord injury (SCI). For standardised comparison, a linear phase reference baseline was used to define target events (i.e., 10%, 40%, 60%, and 90% of the cycle's progress). Limits of agreement (LoA) of ±10% of the cycle's duration and Lin's concordance correlation coefficient (CCC) were used to evaluate the accuracy and precision of the algorithm's event detections. The delays in the detection were determined for each algorithm over 780 events. Analysis showed that the Hilbert and BSgonio algorithms validated the selected criteria (LoA: +5.17/-6.34% and +2.25/-2.51%, respectively), while the GCI Observer did not (LoA: +8.59/-27.89%). When evaluating control algorithms, it is paramount to define appropriate criteria in the context of the targeted practical application. To this end, normalising delays in event detection to the cycle's duration enables the use of a criterion that stays invariable to changes in cadence. Lin's CCC, comparing both linear correlation and strength of agreement between methods, also provides a reliable way of confirming comparisons between new control methods and an existing reference.

Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review.

STUDY DESIGN: Systematic review. OBJECTIVE: To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries. SETTING: Not applicable. METHODS: A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial. RESULTS: Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity. CONCLUSIONS: There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.

Standardizing fatigue-resistance testing during electrical stimulation of paralysed human quadriceps muscles, a practical approach.

BACKGROUND: Rapid onset of muscular fatigue is still one of the main issues of functional electrical stimulation (FES). A promising technique, known as distributed stimulation, aims to activate sub-units of a muscle at a lower stimulation frequency to increase fatigue-resistance. Besides a general agreement on the beneficial effects, the great heterogeneity of evaluation techniques, raises the demand for a standardized method to better reflect the requirements of a practical application. METHODS: This study investigated the fatigue-development of 6 paralysed quadriceps muscles over the course of 180 dynamic contractions, evaluating different electrode-configurations (conventional and distributed stimulation). For a standardized comparison, fatigue-testing was performed at 40% of the peak-torque during a maximal evoked contraction (MEC). Further, we assessed the isometric torque for each electrode-configuration at different knee-extension-angles (70°-170°, 10° steps). RESULTS: Our results showed no significant difference in the fatigue-index for any of the tested electrode-configurations, compared to conventional-stimulation. We conjecture that the positive effects of distributed stimulation become less pronounced at higher stimulation amplitudes. The isometric torque produced at different knee-extension angles was similar for most electrode-configurations. Maximal torque-production was found at 130°-140° knee-extension-angle, which correlates with the maximal knee-flexion-angles during running. CONCLUSION: In most practical applications, FES is intended to initiate dynamic movements. Therefore, it is crucial to assess fatigue-resistance by using dynamic contractions. Reporting the relationship between produced torque and knee-extension-angle can help to observe the stability of a chosen electrode-configuration for a targeted range-of-motion. Additionally, we suggest to perform fatigue testing at higher forces (e.g. 40% of the maximal evoked torque) in pre-trained subjects with SCI to better reflect the practical demands of FES-applications.

Functional mobility assessment is reliable and correlated with satisfaction, independence and skills.

Mobility is essential for activities of daily living and therapists should give priority to evaluate its effects in their client's performance. We aimed to ascertain the intra- and inter-rater reliability of Functional Mobility Assessment (FMA) and to identify correlations among satisfaction, independence, and skills in 44 users of manual wheelchairs and three users of powered wheelchairs. We analyzed the test-retest and inter-rater reliability of the FMA in a sample of 47 wheelchair users using the Cronbach's Alpha. For correlations with FMA were used the Quebec User Evaluation of Satisfaction with Assistive Technology, Functional Independence Measure, and Wheelchair Skills Test Questionnaire (manual and powered forms). The test-retest reliability showed good internal consistency (α > 0.9). Associations between functional independence, wheelchair skills, and functional mobility were significant (p < .05). The Brazilian version of the FMA is reliable for use among wheelchair users, and its correlation with other measurements suggests cohesion among assessments related to mobility devices.

Correlações entre a Participação Ocupacional, Independência e Cognição em Adultos com Deficiência Física / Correlation among Occupational Participation, Independence and Cognition in Adults with Physical Disabilities

RESUMO: A participação ocupacional é uma questão crucial para a atenção à pessoa com deficiência e caracteriza-se pelo grau de participação de uma pessoa em várias ocupações, tais como as de autocuidado, trabalho, escola, lazer, dentre outras. O objetivo deste estudo foi, assim, verificar se a participação ocupacional avaliada pelo Model of Human Occupation Screening Tool (MOHOST Brasil) apresenta correlações com as medidas de independência funcional e de cognição em adultos com deficiências. Foram avaliadas 41 pessoas com deficiência física usando o MOHOST Brasil, a Medida de Independência Funcional (MIF) e o Mini Exame do Estado Mental (MEEM). A subescala motora da MIF apresentou correlação moderada com o fator de habilidades motoras MOHOST (r 0,586 p = 0,001). O item "Linguagem e práxis" do MEEM apresentou correlação moderada com o fator "habilidades de processo" do MOHOST (r 0,573 p = 0,001). As correlações entre o MOHOST e a MIF e entre o MOHOST e o MEEM mostram que há relação entre as dimensões de participação, desempenho e habilidades, confirmando que o MOHOST é útil para avaliar a participação ocupacional de pessoas com deficiências físicas. Conclui-se também que o MOHOST pode fornecer dados que possam contribuir para o planejamento de intervenções que estimulem a participação ocupacional em diferentes papéis no âmbito da Terapia Ocupacional e na sua inferface com a Educação Especial.

ABSTRACT: Occupational participation is a crucial issue for people with disabilities care and it is characterized by the degree of a person's participation in various occupations, such as self-care, work, school, leisure, among others. Thus, this study's objective was to examine if the occupational participation measured by Model of Human Occupation Screening Tool (MOHOST Brazil) has correlations with measures of functional independence and cognition in adults with disabilities. Forty-one (n=41) people with physical disabilities were assessed using the MOHOST Brazil, Functional Independence Measure (FIM) and the Mini-Mental State Examination (MMSE). The FIM's motor subscale presented moderate correlation with the MOHOST motor skills factor (r 0.586 p=0.001). The MMSE's item "Language and praxis" presented moderate correlation with the MOHOST's factor "process skills" (r 0.573 p= 0.001). The correlations between the MOHOST and FIM and between the MOHOST Brazil and MMSE show there is an inter-relation between the dimensions of participation, performance and skills, confirming that the MOHOST is useful for assessing occupational participation of people with disabilities. It is also concluded that MOHOST can provide information that can contribute on planning interventions to support occupational participation in different roles for Occupational Therapy and its possibilities of work in the field of Special Education.

Responsiveness of the Motor Capacities Scale to upper limb reconstructive surgery in persons with tetraplegia due to cervical spinal cord injury.

STUDY DESIGN: Psychometric Study. OBJECTIVES: To assess responsiveness of the Motor Capacities Scale (MCS) in people with tetraplegia who have undergone upper limb reconstructive surgery. SETTINGS: Rehabilitation clinics in France. METHODS: The MCS is an arm/hand function test with 31 basic tasks, subdivided into four sub-categories (MCS A, MCS B, MCS C, and MCS D). Data were recorded preoperatively and following full completion of the surgical program. The Functional Independence Measure (FIM) and a ten-point numeric scale related to patients' satisfaction with the overall surgical result were included. Data were analyzed using responsiveness measures-the effect size (ES), the standardized response mean (SRM), and the minimal clinically important difference (MCID). RESULTS: Twenty-seven participants were included. Fourteen patients underwent unilateral surgery and 13 bilateral surgery. ES and SRM were moderate or good (ES/SRM of MCS B = 0.76/0.81, ES/SRM MCS C = 0.68/0.77, and ES/SRM MCS D = 0.77/0.88). For MCS A and FIM, both SRM and ES showed a small degree of responsiveness. For the MCS total score, the ES value indicated a moderate degree of responsiveness while SRM was excellent. Total MCS score, MCS C subscore and MCS D subscore showed significantly higher ES values in the "bilateral surgery" group than in the "unilateral group". The estimation of MCIDs showed low threshold values of MCS scores changes (total score and subscores) beyond which the satisfaction rate is >6. CONCLUSIONS: This study provides evidence of acceptable responsiveness of the MCS to changes using the SRM following upper limb reconstruction in patients with tetraplegia.

Intra and inter-raters reliability and agreement of stimulus electrodiagnostic tests with two different electrodes in sedated critically-ill patients.

Objective: The aim of the present study was to verify the intra- and inter-rater reliability and agreement of the stimulus electrodiagnostic test (SET) measurements obtained by pen and square electrodes in the vastus lateralis and tibialis anterior muscles. Design: An intra- and inter-rater reliability and agreement study was performed for the SET by two independent raters. Two different sizes of cathode electrodes (1 cm2 and 25 cm2) and two muscles were assessed (tibialis anterior and vastus lateralis). Results: Chronaxie did not change according to the different electrodes. A high intra-rater reliability (0.72 ≤ r ≤ 0.88) was detected independently of the electrode and muscle assessed. Moreover, moderate and almost perfect agreements (0.51 ≤ Kappa ≤ 1.00) were detected on intra-rater assessment. Similar correlations (0.74 ≤ r ≤ 0.79) were found for intra-rater reliability. However, dissimilar inter-rater agreement was detected: Kappa ≤ 0.40 for tibialis anterior and Kappa = 1.00 for vastus lateralis. Conclusion: The SET presented high reliability and moderate agreement in intra-rater evaluations. A fair agreement was found in the inter-rater assessment of the tibialis anterior. Evaluations performed with different electrode sizes did not influence the results. Therefore, the SET should be performed by a unique rater in test retest situations.

Training with FES-assisted cycling in a subject with spinal cord injury: Psychological, physical and physiological considerations.

CONTEXT: People with spinal cord injury (SCI) experience the effects of a sedentary lifestyle very early on. Literature data suggest that programs using FES-assisted cycling would contribute to reduce the consequences of physical inactivity. The objective was to assess the feasibility of 12-month training on a FES-assisted bike of a subject with paraplegia for 21 years, T3, Asia Impairment Scale (AIS) A. An evaluation of morbidity, self-esteem, satisfaction, quality of life and duration of pedaling was performed. The impact on pain, cardiorespiratory function, body composition and bone metabolism were also assessed. FINDINGS: The acceptability score of the training constraints increased from 51 to 59/65 and satisfaction was high around 8/10. The pedaling duration increased from 1' to 26' on the recumbent bike and from 1' to 15' on open terrain. No significant changes were found with BMD and cardiorespiratory measures during exercise tests. SF 36 showed significant improvement of more than 10% and the Rosenberg Self Esteem score rapidly improved from 36 to 39/40. At the end of the training, the patient reached the objective of the Cybathlon 2016 by covering 750 m in less than 8 minutes, at an average speed of 5.80 km/hr. CONCLUSION/CLINICAL RELEVANCE: A person with high and complete level of SCI for more than 20 years can undertake this type of challenge if the prerequisites are met; this training is without danger if the safety precautions are respected; the challenge of participating in a competition had a powerful impact on JP's self-esteem and perceived quality of life.

Cross-cultural adaptation, face validity and reliability of the Model of Human Occupation Screening Tool to Brazilian Portuguese / Adaptação transcultural, validade de face e confiabilidade do Instrumento de Identificação da Participação Ocupacional do Modelo de Ocupação Humana para o português do Brasil

Abstract Introduction The Model of Human Occupation Screening Tool (MOHOST) was developed in the UK and measures the occupational participation. Until its translation, there were no standardised instruments in Brazil of a similar nature. Objectives To describe the translation and cross-cultural adaptation process of the MOHOST for Brazil, its face validity and test-retest reliability among occupational therapists. Method A translation agreement was established allowing the assessment to be translated and honed after a back translation. An expert committee was formed of ten occupational therapists to test face validity of the instrument with 50 occupational therapists. Statistical analysis was employed to investigate whether the occupational therapists' understanding of the MOHOST was linked to their length of clinical experience. The test-retest reliability was examined among a sample of eight adults with physical disabilities. Results The cross-cultural adaptation of the Brazilian MOHOST has been completed. A significant correlation (p=0.04) was found between years of professional experience and greater understanding of the MOHOST items. The MOHOST presented very high reliability in the test-retest (r>0.900). Conclusion A Brazilian translation of the MOHOST has face validation and test-retest reliability. Future studies addressing this instrument's psychometric properties of validity and inter-rater reliability are recommended.

Resumo Introdução O Instrumento de Identificação da Participação Ocupacional do Modelo de Ocupação Humana (MOHOST Brasil) foi desenvolvido no Reino Unido e mensura a participação ocupacional. Até a sua presente tradução, para o Brasil, não haviam instrumentos padronizados e que mensurassem o mesmo constructo. Objetivos Descrever o processo de tradução e adaptação cultural do MOHOST para o Brasil, examinar a sua validade de face e confiabilidade no teste-reteste por terapeutas ocupacionais. Método Inicialmente foi estabelecido um contato para a autorização da tradução e, posteriormente, seguidas as etapas de tradução, retrotradução, comitê de especialistas, validade de face e teste-reteste. O comitê de especialistas foi composto por dez terapeutas ocupacionais. A validade de face contou com a participação de 50 terapeutas ocupacionais. A análise estatística foi empregada para investigar se o entendimento do MOHOST pelos terapeutas ocupacionais estava vinculado à sua duração da experiência clínica. A confiabilidade teste-reteste foi examinada em uma amostra de oito adultos com deficiência física, em um intervalo de uma semana. Resultados A adaptação transcultural do MOHOST (Brasil) foi concluída. Foi encontrada uma correlação significativa (p=0,04) entre anos de experiência profissional e maior entendimento dos itens do MOHOST. O MOHOST apresentou confiabilidade muito alta no teste-reteste (r>0,900). Conclusão A versão brasileira apresenta validação de face e confiabilidade no teste-reteste. Estudos futuros abordando as propriedades psicométricas de validade convergente e confiabilidade entre avaliadores são recomendados.

Assisted Grasping in Individuals with Tetraplegia: Improving Control through Residual Muscle Contraction and Movement.

Individuals who sustained a spinal cord injury often lose important motor skills, and cannot perform basic daily living activities. Several assistive technologies, including robotic assistance and functional electrical stimulation, have been developed to restore lost functions. However, designing reliable interfaces to control assistive devices for individuals with C4-C8 complete tetraplegia remains challenging. Although with limited grasping ability, they can often control upper arm movements via residual muscle contraction. In this article, we explore the feasibility of drawing upon these residual functions to pilot two devices, a robotic hand and an electrical stimulator. We studied two modalities, supra-lesional electromyography (EMG), and upper arm inertial sensors (IMU). We interpreted the muscle activity or arm movements of subjects with tetraplegia attempting to control the opening/closing of a robotic hand, and the extension/flexion of their own contralateral hand muscles activated by electrical stimulation. Two groups were recruited: eight subjects issued EMG-based commands; nine other subjects issued IMU-based commands. For each participant, we selected at least two muscles or gestures detectable by our algorithms. Despite little training, all participants could control the robot's gestures or electrical stimulation of their own arm via muscle contraction or limb motion.

Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients.

Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571-1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury - a systematic review with meta-analysis.

STUDY DESIGN: This work is a systematic review with meta-analysis OBJECTIVE: Evaluate the effect of electrical stimulation (ES) on skeletal muscle volume and spasticity in individuals with spinal cord injury (SCI). SETTING: University of Brasilia, Brazil METHODS: Searches were conducted of the Cochrane Library, MEDLINE, CINAHL, PEDro, PsycINFO and EMBASE electronic databases for relevant articles published up to June 2018. No restrictions were imposed regarding the year of publication. The inclusion criteria were randomized controlled trials involving adults with SCI comparing ES to an active or passive control. Two independent reviewers extracted the data from the selected studies and methodological quality was assessed using the PEDro scale. RESULTS: The initial search led to the retrieval of 164 studies, seven of which met the eligibility criteria, but only six were included in the meta-analysis. The six studies comprised 104 patients with complete or incomplete SCI. In the two studies that investigated the use of ES on muscle volume of the lower limbs, the overall effect was statistically significant in patients with acute SCI (mean difference: 0.86; 95% CI: 0.04 to 1.69; p < 0.04). Among the four studies that examined the use of ES for spasticity of the lower limb, the overall effect was non-significant (mean difference: 0.55; 95% CI: -0.31 to 1.41; p = 0.21). CONCLUSIONS: Electrical stimulation was found to be an effective method for increasing muscle volume in SCI patients, but had no effect on spasticity. Further investigation of the effect of ES on spasticity in SCI is needed.

Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy.

Central nervous system diseases include brain or spinal cord impairments and may result in movement disorders almost always manifested by paralyzed muscles with preserved innervations and therefore susceptible to be activated by electrical stimulation. Functional electrical stimulation (FES)-assisted cycling is an approach mainly used for rehabilitation purposes contributing, among other effects, to restore muscle trophism. FES-assisted cycling has also been adapted for mobile devices adding a leisure and recreational benefit to the physical training. In October 2016, our teams (Freewheels and EMA-trike) took part in FES-bike discipline at the Cybathlon competition, presenting technologies that allow pilots with spinal cord injury to use their paralyzed lower limb muscles to propel a tricycle. Among the many benefits observed and reported in our study cases for the pilots during preparation period, we achieved a muscle remodeling in response to FES-assisted cycling that is discussed in this chapter. Then, we have organized some sections to explore how FES-assisted cycling could contribute to functional rehabilitation by means of changes in the skeletal muscle disuse atrophy.

Inter-rater and test/retest reliabilities of the isokinetic measurements: assessing strength and endurance of the trunk muscles in two different protocols for able-bodied and post-stroke hemiparesis.

Background Stroke represents the largest cause of chronic disability resulting in muscle weakness and instability in the trunk muscles. Despite the reliable measures from isokinetic devices for upper/lower limb muscles, there is a lack of measures for trunk muscles in post-stroke hemiparesis. Objectives To investigate the reliability of the strength and endurance measures from an isokinetic dynamometer for able-bodied and post-stroke hemiparesis people. Methods The measures were taken from both groups (control/hemiparesis) performing antagonistic movements (flexion/extension) during different protocols (seated-compressed and semi-standing) to assess strength (60º/s) and endurance (120º/s). The intra-class correlation coefficient (ICC) and limits of agreement (LOA) defined the quality and magnitude of reliability on the measurements plotted with 95% confidence interval (95% CI) by Bland-Altman method. Results ICC ranged from 0.58 to 0.99, with few ICC values classified as moderate when repeated by raters during test and a single value during retest. The total work was the only variable to present LOA higher than the limits. Conclusion Results indicate acceptable reliability, in two different protocols, confirming the repeatability of the isokinetic measures for trunk muscles in able-bodied and post-stroke hemiparesis.