Managing Scapular Dyskinesis.

Scapular dyskinesis, the impairment of optimal scapular position and motion, is common in association with shoulder injury. A comprehensive evaluation process can show the causative factors and lead to effective treatment protocols. The complexity of scapular motion and the integrated relationship between the scapula, humerus, trunk, and legs suggest a need to develop rehabilitation programs that involve all segments working as a unit rather than isolated components. This is best accomplished with an integrated rehabilitation approach that includes rectifying deficits in mobility, strength, and motor control but not overtly focusing on any one area.

Research on kinect based training system for sports obstacle assessment / Pesquisa no sistema de treinamento baseado no kinect para avaliação de obstáculos esportivos / Investigación sobre el sistema de entrenamiento basado en kinect para la evaluación de obstáculos deportivos

ABSTRACT Objective: The study draws attention to designing a dyskinesia assessment system using a Kinect sensor to improve the efficiency of rehabilitation training. Methods: The login page design. Step 2: System functions setting. Relevant movement guidance content and rehabilitation evaluation content are incorporated in the system to make rehabilitation training efficient and orderly. Comprehensive data processing, evaluation, and export functions are necessary to reference rehabilitation physicians in diagnosis and treatment. Step 3: System modules design. Based on the system settings, corresponding functional modules have been designed and developed. With each module realizing its specific functions, it must be ensured that there is a certain degree of correlation between the modules. Step 4: The system function framework design. Results: A simple and comfortable login page is designed; 2. The system is capable of rehabilitation training and data management; 3. Specifically designed modules include sports collection module, rehabilitation training module, rehabilitation evaluation module, and information management module; 4. After logging in, the patient should first search for the rehabilitation plan in the rehabilitation training function module and then perform rehabilitation training regarding the rehabilitation plan. Kinect synchronously obtains patient sports information throughout the training process, and patients can obtain rehabilitation assessment information and automatically save it in the information management module. Conclusions: The Kinect-based dyskinesia assessment and training system designed in this study can heighten the efficiency of rehabilitation training for patients with dyskinesia, and it is highly suggested in clinical practice. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Objetivo: O estudo chama a atenção para o projeto de um sistema de avaliação de discinesia usando sensor Kinect para melhorar a eficiência do treinamento de reabilitação. Métodos: O design da página de login. Etapa 2: configuração das funções do sistema. Conteúdo de orientação de movimento relevante e conteúdo de avaliação de reabilitação são incorporados ao sistema para tornar o treinamento de reabilitação eficiente e ordenado. Funções abrangentes de processamento, avaliação e exportação de dados são necessárias para fornecer referência para médicos de reabilitação em diagnóstico e tratamento. Etapa 3: Projeto dos módulos do sistema. Com base nas configurações do sistema, os módulos funcionais correspondentes foram projetados e desenvolvidos. Com cada módulo realizando suas funções específicas, deve-se garantir que haja um certo grau de correlação entre os módulos. Etapa 4: O design da estrutura de funções do sistema. Resultados: Uma página de login simples e confortável é projetada; 2. O sistema é capaz de treinamento de reabilitação e gerenciamento de dados; 3. Módulos especificamente projetados incluem módulo de coleta de esportes, módulo de treinamento de reabilitação, módulo de avaliação de reabilitação e módulo de gerenciamento de informações; 4. Após o login, o paciente deve primeiro pesquisar o plano de reabilitação no módulo de função de treinamento de reabilitação e, em seguida, realizar o treinamento de reabilitação com referência ao plano de reabilitação. O Kinect obtém de forma síncrona informações sobre esportes do paciente durante o processo de treinamento, e os pacientes podem obter informações de avaliação de reabilitação e salvá-las automaticamente no módulo de gerenciamento de informações. Conclusões: O sistema de avaliação e treinamento de discinesia baseado no Kinect projetado neste estudo pode aumentar a eficiência do treinamento de reabilitação para pacientes com discinesia, e é altamente sugerido na prática clínica. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Objetivo: El estudio llama la atención para el diseño de un sistema de evaluación de la discinesia utilizando el sensor Kinect para mejorar la eficiencia del entrenamiento de rehabilitación. Métodos: Diseño de la página de inicio de sesión. Paso 2: Configuración de las funciones del sistema. El contenido de la guía de movimiento relevante y el contenido de evaluación de la rehabilitación se incorporan en el sistema para hacer que la capacitación en rehabilitación sea eficiente y ordenada. Las funciones integrales de procesamiento, evaluación y exportación de datos son necesarias para proporcionar referencia a los médicos rehabilitadores en el diagnóstico y el tratamiento. Paso 3: Diseño de los módulos del sistema. Sobre la base de la configuración del sistema, se han diseñado y desarrollado los módulos funcionales correspondientes. Con cada módulo realizando sus funciones específicas, debe asegurarse que existe un cierto grado de correlación entre los módulos. Paso 4: El diseño del marco de la función del sistema. Resultados: Se diseña una página de inicio de sesión simple y cómoda; 2. El sistema es capaz de entrenamiento en rehabilitación y manejo de datos; 3. Los módulos específicamente diseñados incluyen el módulo de recolección de deportes, el módulo de capacitación en rehabilitación, el módulo de evaluación de la rehabilitación y el módulo de gestión de la información; 4. Después de iniciar sesión, el paciente debe buscar primero el plan de rehabilitación en el módulo de función de entrenamiento de rehabilitación y luego realizar el entrenamiento de rehabilitación con referencia al plan de rehabilitación. Kinect obtiene de forma sincrónica la información deportiva del paciente durante todo el proceso de entrenamiento, y los pacientes pueden obtener información sobre la evaluación de la rehabilitación y guardarla automáticamente en el módulo de gestión de información. Conclusiones: El sistema de evaluación y entrenamiento de discinesia basado en Kinect diseñado en este estudio puede aumentar la eficiencia del entrenamiento de rehabilitación para pacientes con discinesia, y está altamente recomendado en la práctica clínica. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Kinematic analysis of the human body during sit-to-stand in healthy young adults.

ABSTRACT: Sit-to-stand (STS) motion is one of the most important and energy-consuming basic motions in everyday life. Kinematic analysis provides information regarding what strategy or motion pattern is used by the healthy people, and through which, we can understand and obtain the law of the STS motion. The objective of this article is to study the law of STS motion through the experiment to determine a suitable description of STS motion in healthy adults, so as to provide a starting point and bases for future design and control of STS assistive devices.Thirty healthy adult subjects participated in this study and carried out STS motion experiment of standing up naturally. The STS motions were recorded using a high-definition camera. The experimentally collected kinematic data and a link segment model of the human body were used to obtain the coordinates of joints and to calculate the coordinates, velocity, and momentum of center of gravity; the postures of human body during STS are also obtained. The relationship between human body parameters and motion parameters is analyzed by using Pearson correlation method.The STS motion is divided into 4 phases; the phases are differentiated in terms of STS motion characteristics and postures, and momentum of center of gravity of human body. The main factors determining the differences in STS motion among individuals are horizontal distance between hip joint and ankle joint, lower leg length, thigh length, and the length of the transition period. The horizontal distance between hip joint and ankle joint is positively correlated with the duration from motion begin to trunk stops flexing forward (P = .021 < .05), but not so with the duration from motion begin to the end of phase 2 (P = .15 > .05).The results suggest that when designing the sit-to-stand assistive devices, one should pay attention to the whole-body posture control in STS motion, such as the posture guidance of trunk and lower leg, and should carry out specific training according to different STS phases. Sit-to-stand assistive devices should provide the same horizontal distance between hip joint and ankle joint for different individuals during the STS motion. Transition period should be properly controlled, and the degree of freedom of the lower leg should not be limited.

Motor Dysfunction in REM Sleep Behavior Disorder: A Rehabilitation Framework for Prodromal Synucleinopathy.

Parkinson disease (PD) and other related diseases with α-synuclein pathology are associated with a long prodromal or preclinical stage of disease. Predictive models based on diagnosis of idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) make it possible to identify people in the prodromal stage of synucleinopathy who have a high probability of future disease and provide an opportunity to implement neuroprotective therapies. However, rehabilitation providers may be unaware of iRBD and the motor abnormalities that indicate early motor system dysfunction related to α-synuclein pathology. Furthermore, there is no existing rehabilitation framework to guide early interventions for people with iRBD. The purpose of this work is to (1) review extrapyramidal signs of motor system dysfunction in people with iRBD and (2) propose a framework for early protective or preventive therapies in prodromal synucleinopathy using iRBD as a predictive marker. Longitudinal and cross-sectional studies indicate that the earliest emerging motor deficits in iRBD are bradykinesia, deficits performing activities of daily living, and abnormalities in speech, gait, and posture. These deficits may emerge up to 12 years before a diagnosis of synucleinopathy. The proposed rehabilitation framework for iRBD includes early exercise-based interventions of aerobic exercise, progressive resistance training, and multimodal exercise with rehabilitation consultations to address exercise prescription, progression, and monitoring. This rehabilitation framework may be used to implement neuroprotective, multidisciplinary, and proactive clinical care in people with a high likelihood of conversion to PD, dementia with Lewy bodies, or multiple systems atrophy.

Eye Gaze Gaming Intervention in Children with Dyskinetic Cerebral Palsy: A Pilot Study of Task Performance and Its Relation with Dystonia and Choreoathetosis.

OBJECTIVES: To investigate the operational competences screen navigation and dwell function underlying eye gaze performance, and the relation of dystonia and choreoathetosis with eye gaze performance in children with dyskinetic cerebral palsy (DCP). METHODS: During a 5-week intervention, ten participants with DCP played eye gaze video games daily for 30 minutes. Six games were used to assess task performance, fixation count, and eye movement accuracy during four measurements. Dystonia and choreoathetosis were evaluated using the Dyskinesia Impairment Scale. RESULTS: Eye gaze performance improved over time (p = .013). Moderate to strong within-subject correlations were found between eye movement accuracy and task performance, and between eye movement accuracy and fixation count. No significant correlations were found with the movement disorders. CONCLUSIONS: Eye gaze technology shows great potential to be a successful computer interface for children with severe DCP, thereby potentially improving their communication skills, participation levels, and quality of life.

Parkinson's Disease Multimodal Complex Treatment improves motor symptoms, depression and quality of life.

Parkinson's disease (PD) is the world's fastest growing neurological disorder disabling patients through a broad range of motor and non-motor symptoms. For the clinical management, a multidisciplinary approach has increasingly been shown to be beneficial. In Germany, inpatient Parkinson's Disease Multimodal Complex Treatment (PD-MCT) is a well-established and frequent approach, although data on its effectiveness are rare. We conducted a prospective real-world observational study in 47 subjects [age (M ± SD): 68.5 ± 9.0 years, disease duration: 8.5 ± 5.3 years, modified Hoehn and Yahr stage (median, IQR): 3, 2.5-3] aiming at evaluating the effectiveness of 14-day PD-MCT in terms of quality of life (Parkinson's Disease Questionnaire, EuroQol), motor [Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III], Timed Up and Go Test, Purdue Pegboard Test) and non-motor symptoms (revised Beck Depression Inventory). Six weeks after hospital discharge, a follow-up examination was performed. PD patients with a predominantly moderate disability level benefited from PD-MCT in terms of health-related quality of life, motor symptoms and non-motor symptoms (depression). Significant improvements were found for social support, emotional well-being and bodily discomfort domains of health-related quality of life. Sustainable improvement occurred for motor symptoms and the subjective evaluation of health state. We found a higher probability of motor response especially for patients with moderate motor impairment (MDS-UPDRS III ≥ 33). In conclusion, Parkinson's Disease Multimodal Complex Treatment improves motor symptoms, depression and quality of life. A more detailed selection of patients who will benefit best from this intervention should be examined in future studies.

CONSORT-Assistive technology-180° rotating eating spoon improves the ability of eating of self-care patients with upper extremity dyskinesia: Rotating eating spoon improves eating ability.

OBJECTIVE: This study aims to develop an assistive technology-180° rotating feeding spoon that could improve the ability of eating of self-care patients with upper extremity dyskinesia. METHODS: The Brunnstrom 6-stage rating of hemiplegia was adopted. During the different recovery stages of the upper limbs, the patients orally ate using a feeding spoon with a non-rotatory head and a 180° rotating feeding spoon. The ability of these patients to eat by themselves was observed, and the basic activity of daily living (BADL) was assessed using the Barthel index (BI). RESULTS: The Brunnstrom assessment scale was used to analyze the results of the patient's upper limb function examination, and the results revealed that the 180° rotating feeding spoon could assist patients with different degrees of upper limb dysfunction when eating independently. CONCLUSIONS: The 180° rotating feeding spoon can assist patients with upper limb dysfunction when eating independently. For patients with different degrees of upper limb dysfunction, the spoon can provide different degrees of aid.

Categorisation of goals set using Goal Attainment Scaling for treatment of leg spasticity: a multicentre analysis.

Background: Goal-classification of person-centred goals, using Goal Attainment Scaling for leg spasticity treatment. Methods: The study was conducted in two phases: phase I, a retrospective review to evaluate categories of goal set in routine clinical practice. Findings were used to design a goal classification system. Phase II, a multi-centre study to confirm the goal categories. Goals set (n = 270) were analysed from data collected at three centres in the UK (one centre for phase I). Goal categories were mapped onto the domains of the World Health Organisation, International Classification of Functioning Disability and Health. Results: One hundred and twenty seven participants were recruited in two cohorts: phase I: 63; phase II: 64. Goal categories using both cohorts were assigned to two domains, each subdivided into three key goal categories: Domain 1: body structure impairment 121 (44%): (a) pain/discomfort 34 (12%), (b) involuntary movements 20 (7%), and (c) range of movement/contracture prevention 67 (25%). Domain 2: activity function 149 (56%): (a) passive function (ease of caring for the affected limb) n = 89 (33%), (b) active function (transfers) 26 (10%), and (c) active function (mobility) 27 (10%), other n = 7 (3%). Conclusions: Patients individual leg spasticity goals can be grouped into six categories and two domains, which will assist clinicians, patients and cares in setting and evaluating goals in practice. Implications for Rehabilitation Six goal areas used in clinical goal setting for leg spasticity management were identified, under the two domains: (1) body structure impairment: pain, involuntary movements, and range of movement and (2) activities/function: passive function (ease of caring), active function - transfers or standing and active function - mobility. Categorisation of goals is consistent on repeated evaluation and across different clinical services. Using clinical goals for leg spasticity treatment is an effective method to identify treatment priorities.

Effects of trapezius kinesio taping on scapular kinematics and associated muscular activation in subjects with scapular dyskinesis.

STUDY DESIGN: Crossover repeated-measure design. INTRODUCTION: Scapular dyskinesis rehabilitation programs that focus on inhibiting upper trapezius (UT) and activating the lower trapezius (LT) may assist in restoring scapular movements. We hypothesized that taping may be able to normalize scapular movements and associated muscular recruitment. PURPOSE OF THE STUDY: The purpose of this study was to investigate the immediate effects of kinesio taping over trapezius on scapular kinematics and muscular activation in different dyskinesis patterns. We expected that taping can improve scapular kinematics and muscular activation in subjects with dyskinesis. METHODS: Fifty-four participants with inferior angle prominence (pattern I), medial border prominence (pattern II), and mixed pattern (pattern I + II) were recruited. Kinesio taping was applied over 3 parts of trapezius muscles, including UT, middle trapezius (MT), and LT. The scapular kinematics and electromyographic data of trapezius and serratus anterior were collected during scapular plane elevation without taping and after each taping application. RESULTS: UT taping decreased UT activity (5%-7%; P = .001-.003) in 72% of participants with pattern II and pattern I + II dyskinesis, with increased posterior tipping (2.2°-2.5°; P = .003) in pattern II dyskinesis. MT taping increased UT activity (3%; P = .003) in 48% of participants with pattern II dyskinesis. DISCUSSION: The taping over the trapezius muscle may help to restore coordinated scapular muscle balance and increased upward rotation of the scapula, especially in pattern II dyskinesis. Although no electromyography or kinematic difference was found with LT taping in each dyskinesis pattern, methods of applying LT taping need to be further investigated. CONCLUSION: Reduced UT muscle activity and scapular posterior tipping are appropriate when applying taping over UT muscle in patterns II and I + II dyskinesis. Caution should be taken when applying taping over MT and LT muscles in terms of increased UT activity, especially in pattern II dyskinesis.

Jaw Exercise Therapy and Psychoeducation to Reduce Oral Parafunctional Activities for the Management of Persistent Dentoalveolar Pain.

Objective: To retrospectively analyze the effects of our original combination therapy treatment on patients with nonodontogenic persistent dentoalveolar pain. Methods: Twenty-one patients suffering from persistent dentoalveolar pain (nineteen females and two males; mean age ± standard deviation: 55.7 ± 19.6 years) participated in this study. They were treated with a therapy combination of jaw exercise and psychoeducation to reduce oral parafunctional activities every month. The intensity of pain in these subjects was evaluated using a numerical rating scale (NRS) before and after treatment. Results: The NRSs at the baseline ranged from 5 to 10 (median, 8), from 0 to 10 (median, 2) at one month after treatment, from 0 to 10 (median, 1) at three months after treatment, and from 0 to 10 (median, 0) at the end of treatment. Pain intensity after treatment improved significantly. Conclusion: There was a significant reduction in pain after our combination of therapies as nonpharmacological treatments, and therefore this treatment could be useful in the management of NPDP patients.

A Model to Estimate the Optimal Layout for Assistive Communication Touchscreen Devices in Children With Dyskinetic Cerebral Palsy.

Excess involuntary movements and slowness of movement in children with dyskinetic cerebral palsy often result in the inability to properly interact with augmentative and alternative communication (AAC) devices. This significantly limits communication. It is, therefore, essential to know how to adjust the device layout in order to maximize each child's rate of communication. The aim of this paper was to develop a mathematical model to estimate the information rate in children with dyskinetic cerebral palsy and to determine the optimal AAC layout for a touchscreen tablet that results in enhanced speed of communication. The model predicts information rate based on button size, number, spacing between buttons, and the probability of making an error or missing target buttons. Estimation of the information rate confirmed our hypothesis of lower channel capacity in children with dyskinetic cerebral palsy compared with age-matched healthy children. Information rate increased when the AAC layout was customized based on the optimal parameters predicted by the model. In conclusion, this paper quantifies the effect of motor impairments on communication with assistive communication devices and shows that communication performance can be improved by optimally matching the parameters of the AAC touchscreen device to the abilities of the child.

Efectividad del uso de seating de posicionamiento en niños con parálisis cerebral discinética: revisión sistemática / Effectiveness of the use of seating devices in children with dyskinetic cerebral palsy: a systematic reviewx

Introduction: To assess the effectiveness of seating devices during the sitting position on postural stability and upper limb functionality in users with dyskinetic type cerebral palsy. Method: A systematic review that included randomized, quasi-randomized, cohort, and pre-post intervention clinical trials with evaluation before and after the intervention. This review included studies of chil-dren with a diagnosis of cerebral palsy, mainly of the dyskinetic type, with ages between 2 and 10 years old. The databases of CINAHL Plus, Cochrane (Central), EMBASE (Via Ovid), Virtual Health Library, OT Seeker, Medline (Via PubMed) and OpenGrey were used. Results: Two studies met the inclusion criteria; however, the analysis was carried out qualitatively due to the methodological quality for these, with presence of a high risk of bias. The study by Cimolin described greater trunk stability and smooth upper extremity movements with the use of a dynamically configured seat. Nwaobi described better upper extre-mity functionality in a seat inclined at 0º and 30º, not referring to trunk stability. Conclusion: From the review of the results it is concluded that there is not enough scientific evidence to determine that the use of seating devices favors the postural control and the functionality of upper extremities in children with cerebral dyskinesia type cerebral palsy.

Introducción: Evaluar la eficacia del posicionamiento sedente en la estabilidad postural y funcionalidad de extremidades superiores, en ni-ños con parálisis cerebral discinética, comparando el uso y el no uso de seating de posicionamiento. Método: Revisión siste-mática incluyendo ensayos clínicos de tipo aleatorio, cuasialeatorizado, de cohorte y casos con evaluación antes y después de la intervención. Se incluyó niños con parálisis cerebral discinético, entre 2 y 10 años de edad. Se utilizó bases de datos de CI-NAHL Plus, Cochrane (Central), EMBASE (Vía Ovid), Biblioteca Virtual de la Salud, OT Seeker, Medline (Via PubMed) y Open Grey. Resultados: Dos estudios cumplieron criterios de inclusión, aunque el análisis se realizó de forma cualitativa por la calidad metodológica de estos. Cimolin detectó mayor estabilidad de tronco y suavidad en los movimientos de extremidades superiores con el uso de un asiento de configuración dinámica. Nwaobi describió mejor funcionalidad de extremidad superior en un asiento inclinado a 0º y 30º, no haciendo referencia a la estabilidad de tronco. Conclusión: De la revisión de los resulta-dos, se concluye que no existe evidencia científica suficiente que determine que el uso de seating favorezca o no el control postural y la funcionalidad de extremidades superiores en niños y jóvenes con parálisis cerebral de tipo discinética.

[Clinical effects of high frequency repeated transcranial magnetic stimulation therapy on dyskinesia in patients with incomplete spinal cord injury:a Meta-analysis].

OBJECTIVE: To systematically evaluate the clinical effect of high frequency repeated transcranial magnetic stimulation(HF rTMS)therapy on dyskinesia in patients with incomplete spinal cord injury. METHODS: Randomized controlled trials(RCTs) about HF rTMS therapy on patients with motor incomplete spinal cord injury were searched electronically in PubMed, Google scholar, Cochrane library, Clinical trial, Medline, Web of science, CNKI, VIP, and Wanfang database before October 2016. Two reviewers independently screened the literatures according to the inclusion and exclusion criteria, as well as extracted the data and assessed the methodological quality. The observed outcomes included ASIA motor score, ASIA lower extremities motor score(LEMS), Modified Ashworth score (MAS), Ten-meter walking test (10MWT) and Walking index for SCI II(WISCI II), and the outcomes were analyzed using RevMan5.2 software provided by the Cochrane information management system. RESULTS: Five RCTs involved 103 patients were included, and 61 patients(experimental group) accepted real rTMS and physical rehabilitation care for SCI, 51 patients(control group) accepted only physical rehabilitation care. There were significant differences in ASIA motor score, LEMS and 10MWT between two groups after HF rTMS therapy (statistics were Z=2.96, P=0.003; Z=3.04, P=0.002; Z=2.16, P=0.03; respectively). When stimulating the leg motor cortex, there was significant difference in MAS between two groups(Z=2.79, P=0.005), and when stimulating the vertex, there was no significant difference(Z=0.09, P=0.93). There was no significant difference in WISCI IIscore after HF rTMS therapy between two groups(Z=0.90, P=0.37). CONCLUSIONS: HF rTMS can raise motor score in patients with incomplete spinal cord injury, improve the spasticity of the lower extremities, and increase the motor ability.

Mirror therapy for involuntary movement due to chronic thalamic hemorrhage: a case report.

BACKGROUND: Some stroke survivors suffer from involuntary movement, which often disturbs upper-limb function, but there are few effective modality options. CASE REPORT: A 70-year-old man presented with persisting right-upper-limb hemiballism due to left thalamic hemorrhage ten years before. We provided inpatient rehabilitation, including repetitive-facilitative exercise and task-related training, and prescribed clonazepam from day 5 after admission. However, the affected upper limb showed no significant change and remained nonfunctional. When we introduced mirror therapy (MT) to the rehabilitation program on day 14, hemiballism immediately decreased during the MT session, so we added daily MT sessions of 20 min/day. At discharge on day 42, he was able to use his right hand for eating meals and folding laundry. CLINICAL REHABILITATION IMPACT: This shows that MT may have the potential to be a novel therapeutic method for treating involuntary movement. Further research is needed to elucidate mechanisms by which MT may reduce hemiballism.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study.

OBJECTIVE: To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention. METHODS: Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities. RESULTS: Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high. DISCUSSION: The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Management of Severe Hemiballismus: Treatment Challenges in the Acute Inpatient Rehabilitation Setting: A Case Presentation.

We report a case of a patient with profound right-sided hemiballismus resulting from an acute unilateral left thalamic lesion. The hemiballismus was significant and persistent, resulting in profound functional disability. We discuss the use of low-dose haloperidol in conjunction with acute rehabilitation in the treatment of hemiballismus, resulting in decreased amplitude and frequency of adventitious movements and leading to substantial functional gains in our patient. To our knowledge, this is the first extensive report of successful rehabilitation of a patient with functionally disabling hemiballismus. LEVEL OF EVIDENCE: V.

Critical and Theoretical Perspective on Scapular Stabilization: What Does It Really Mean, and Are We on the Right Track?

Stabilization exercises have been a focus and mainstay of many therapeutic and performance training programs in the past decade. Whether the focus is core stabilization for the spine or scapular stabilization, clinicians and trainers alike have endorsed these programs, largely on the basis of conceptual theory and anecdotal experience. The notion that an unstable scapula is related to shoulder dysfunction and pathology is well accepted, but is it accurate? The aim of this perspective article is to challenge the concept of scapular stabilization through the application of biomechanical and motor control constructs. The objectives are to critically examine current beliefs about scapular stabilization, to discuss definitions of stabilization and stability in the context of the scapulothoracic region, and to evaluate key evidence regarding scapular stabilization and scapular dyskinesia. Several new approaches that may affect the understanding of normal and atypical scapula motion are explored. Finally, a historical analogy is presented and future research and clinical directions are suggested. The aims are to lead readers to the essential concepts implied on scapular stabilization, to increase the critical thought process in rehabilitation practice, and to suggest some open topics to be explored in future research.

Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome.

Scapular dyskinesis, characterized by scapular downward rotation syndrome (SDRS) affects scapula-humeral rhythm and results in shoulder dysfunction. Previous study has led to the recommendation of standard shrug exercise to contend with SDRS and strengthen the upper trapezius (UT) muscle. However, few researchers have examined which shrug exercise is most effective. The aim of this research was to compare scapular kinematic changes and scapular rotator muscles activity across three different shrug exercises in SDRS. The amounts of scapular downward rotation were measured by a caliper and the scapular upward rotation angle was measured using two digital inclinometers. Surface electromyography was used to measure EMG amplitude from the UT, lower trapezius (LT), serratus anterior (SA), and levator scapula (LS). Seventeen subjects with SDRS were recruited for this study. The subjects performed three shrug exercises with 30° shoulder abduction (preferred shrug, frontal shrug, and stabilization shrug). The stabilization shrug showed a significantly greater scapular upward rotation angle compared with the preferred shrug (P=0.004) and frontal shrug (P=0.006). The UT activity was significantly greater in the frontal shrug than in the preferred shrug (P=0.002). The UT/LS muscle activity ratio was also significantly greater in the frontal shrug than in the preferred shrug (P=0.004). The stabilization shrug should be preferred to enhance the upward rotation angle. In addition, the frontal shrug can be used as an effective method to increase UT activity and to decrease LS activity in SDRS.

The motor recovery related with brain lesion in patients with intracranial hemorrhage.

Although studies have demonstrated that several specific brain lesions are related to the severity of functional outcomes, the effects of specific brain lesions are not yet clear. This study investigated the effects of hemorrhagic stroke lesions on motor recovery. Eleven subjects with hemorrhagic stroke were assessed. Using the Fugl-Meyer Assessment and functional ambulation category, clinical motor and sensory impairments were tested four times in total: initially within 2 weeks and 1, 3, and 6 months after the onset of stroke. Brain lesions and size were evaluated using MRIcron, SPM8, and Talairach Daemon software. Trunk control, motor function in the lower limbs, and sensory function improved significantly within 3 months, after which the change was no longer significant. Upper limb function and gait were unchanged within 1 month but improved significantly 3 months after onset and continued to improve for 6 months. Involvement of the anterior putamen, internal capsule, thalamus, periventricular white matter, and premotor cortex was related to poor upper limb recovery in patients with hemorrhagic stroke. These results should be useful for planning rehabilitation strategies and understanding the prognosis of hemorrhagic stroke.

Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation.

PURPOSE: Scapular dyskinesis has been related to acromioclavicular injuries. A rehabilitation protocol has been studied in order to treat scapular dyskinesis, but it has not yet been evaluated. This rehabilitation programme was adopted to improve the shoulder function, thereby improving the scapular dyskinesis in patients with chronic acromioclavicular dislocation. METHOD: Twenty-four patients diagnosed with chronic type III acromioclavicular dislocation and scapular dyskinesis that have already been conservatively treated were enrolled in the rehabilitation protocol and analysed. Fourteen of these patients had a Scapular Inferior Coracoid dysKinesis (SICK) Syndrome. The adopted rehabilitation protocol consisted of 12 strengthening and stretching exercises of the scapulae. The final follow-ups were performed after 6 weeks, 6 months and 12 months using clinical measurements of scapular position and clinical evaluation of the scapular motion. In order to evaluate the SICK scapula syndrome, we used the SICK Scapula Rating Scale. The shoulder function was evaluated with a Constant Score and a Subjective Shoulder Value. RESULTS: After 12 months, the follow-up concluded that the scapular dyskinesis was no longer present in 18/23 patients (78.2 %). SICK scapula syndrome was observed in 4/8 patients with a scapular malposition. The Scapula Rating Scale score in 4 patients with SICK scapula was 7.5 points. After 12 months of rehabilitation, the mean Constant Score and Subjective Shoulder Value grew up to 85 points. CONCLUSION: The scapular dyskinesis and SICK syndrome secondary to chronic type III AC dislocation can be treated with the proposed rehabilitation protocol resulting in positive improvements of the shoulder function within 6 weeks; however, patients that do not respond to the rehabilitation programme will not improve with extended rehabilitation time. It is important to advise patients of the specific exercises for the prevention/treatment of scapular dyskinesis in the rehabilitation programme after AC joint dislocation. LEVEL OF EVIDENCE: IV.