Search Results (15)

Background/Objectives: Standing training is essential for individuals with spinal cord injury (SCI), yet maintaining regular practice after acute rehabilitation remains challenging. To address the need for more practical and accessible standing equipment, we developed a novel spring-assisted standing training device designed to overcome barriers to regular standing practice. This study aimed to assess the safety and feasibility of our newly developed device in individuals with SCI. Methods: Six participants with chronic SCI (neurological level of injury T4-L3, American Spinal Injury Association Impairment Scale A-C; 2 females, mean age 41.7 ± 13.4 years) underwent a single session using our chair-based device incorporating passive gas spring mechanisms. We designed this device to enable independent sit-to-stand transitions without electrical power or complex controls. Primary outcomes included safety (adverse events) and feasibility (number of repetitions, Modified Borg Scale). Changes in Modified Ashworth Scale (MAS) scores were assessed as exploratory measures. Results: All participants successfully completed training without adverse events. Repetitions ranged from 5 to 60 (median 37), with Modified Borg Scale ratings of 0–4. Notably, the participant with T4 complete injury performed the training without requiring trunk orthosis, demonstrating the device’s inherent stability. MAS sum scores showed a reduction from median 8.75 to 4.25, though this did not reach statistical significance (p = 0.13). Conclusions: Our newly developed spring-assisted standing training device proved safe and feasible for individuals with SCI, including those with complete thoracic injuries. The device successfully enabled independent sit-to-stand transitions with low perceived exertion, potentially addressing key barriers to regular standing practice and offering a practical rehabilitation solution. Full article

In Paralympic sports, to guarantee fair competition, it is necessary to identify those peculiar abilities that characterize the discipline and the motor limitations that may or may not most affect the athlete’s performance in a specific sports task, assigning an appropriate classification to the level of impairment. This study proposes a minimally invasive assessment system based on a single inertial sensor to support the investigation of the peculiarities of water polo with disabilities by analyzing players’ trunk inclinations during a simulated match and angular speeds in swimming tests. By comparing a small group of athletes of various classes and those without disabilities, we intended to evaluate whether athletes with lower limb disabilities may be disadvantaged compared to athletes with upper limb disabilities. The results suggest no difference in the mean percentage of time in vertical and horizontal positions when comparing players with and without disabilities, although specific impairments led to distinct behaviors (Δ = 0.9%, p = 0.841). Interesting insights emerged in swimming and turning situations in the water. Strong correlations (r > 0.7, p < 0.05) were found between swimming performance metrics and classification points. Furthermore, players with spasticity exhibited lower smoothness in turning movements, suggesting less fluid execution than those with other impairments affecting the same limbs. These findings highlight the IMU system’s potential to provide objective, quantitative data for refining WPA classification protocols. Full article

Postural control arises from the complex interplay of stability, adaptability, and dynamic adjustments, which are disrupted post-stroke, emphasizing the importance of examining these mechanisms during functional tasks. This study aimed to analyze the complexity and variability of postural control in post-stroke individuals during the feedforward phase of gait initiation. A cross-sectional study analyzed 17 post-stroke individuals and 16 matched controls. Participants had a unilateral ischemic stroke in the chronic phase and could walk independently. Exclusions included cognitive impairments, recent surgery, and neurological/orthopedic conditions. Kinematic and kinetic data were collected during 10 self-initiated gait trials to analyze centre of pressure (CoP) dynamics and joint angles (−600 ms to +50 ms). A 12-camera motion capture system (Qualisys, Gothenburg, Sweden) recorded full-body kinematics using 72 reflective markers placed on anatomical landmarks of the lower limbs, pelvis, trunk, and upper limbs. Ground reaction forces were measured via force plates (Bertec, Columbus, OH, USA) to compute CoP variables. Linear (displacement, amplitude, and velocity) and non-linear (Lyapunov exponent—LyE and multiscale entropy—MSE) measures were applied to assess postural control complexity and variability. Mann–Whitney U tests were applied (p < 0.05). The stroke group showed greater CoP displacement (p < 0.05) and reduced velocity (p = 0.021). Non-linear analysis indicated lower LyE values and reduced complexity and adaptability in CoP position and amplitude across scales (p < 0.05). In the sagittal plane, the stroke group had higher displacement and amplitude in the head, trunk, pelvis, and limbs, with reduced LyE and MSE values (p < 0.05). Frontal plane findings showed increased displacement and amplitude in the head, trunk, and ankle, with reduced LyE and MSE (p < 0.05). In the transverse plane, exaggerated rotational patterns were observed with increased displacement and amplitude in the head, trunk, pelvis, and hip, alongside reduced LyE convergence and MSE complexity (p < 0.05). Stroke survivors exhibit increased linear variability, indicating instability, and reduced non-linear complexity, reflecting limited adaptability. These results highlight the need for rehabilitation strategies that address both stability and adaptability across time scales. Full article

The motor features of people with cerebellar ataxia suggest that locomotion is substantially impaired due to incoordination of the head, trunk, and limbs. The purpose of this study was to investigate how well a wearable soft passive exoskeleton worked for motor coordination in these patients. We used an optoelectronic system to examine the gait of nine ataxic people in three different conditions: without an exoskeleton and with two variants of the exoskeleton, one less and the other more flexible. We investigated kinematics using trunk ranges of motion, the displacement of the center of mass in the medio-lateral direction, and the parameters of mechanical energy consumption and recovery. Furthermore, we investigated the lower limb and trunk muscle coactivation. The results revealed a reduction of the medio-lateral sway of the center of mass, a more efficient behavior of the body in the antero-posterior direction, an energy expenditure optimization, a reduction of muscle coactivation and a better coordination between muscle activations. As a result, the findings laid the groundwork for the device to be used in the rehabilitation of individuals with cerebellar ataxia. Full article

Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation—ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = −0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = −0.36, p = 0.04) and the ATR (β = −0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side. Full article

The ability of the lumbar extensor muscles to accurately control static and dynamic forces is important during daily activities such as lifting. Lumbar extensor force control is impaired in low-back pain patients and may therefore explain the variances in lifting kinematics. Thirty-three chronic low-back pain participants were instructed to lift weight using a self-selected technique. Participants also performed an isometric lumbar extension task where they increased and decreased their lumbar extensor force output to match a variable target force within 20–50% lumbar extensor maximal voluntary contraction. Lifting trunk and lower limb range of motion and angular velocity variables derived from phase plane analysis in all planes were calculated. Lumbar extensor force control was analyzed by calculating the Root-Mean-Square Error (RMSE) between the participants’ force and the target force during the increasing (RMSE_A), decreasing (RMSE_D) force portions and for the overall force error (RMSE_T) of the test. The relationship between lifting kinematics and RMSE variables was analyzed using multiple linear regression. Knee angular velocity in the sagittal and coronal planes were positively associated with RMSE_A (R² = 0.10, β = 0.35, p = 0.046 and R² = 0.21, β = 0.48, p = 0.004, respectively). Impaired lumbar extensor force control is associated with increased multiplanar knee movement velocity during lifting. The study findings suggest a potential relationship between lumbar and lower limb neuromuscular function in people with chronic low-back pain. Full article

Background: Most Hemiplegic patients achieve ambulatory function during the sub-acute stage of stroke. Though ambulatory, they still perform an unpleasant awkward gait with remarkable compensations requiring more energy expenditure. Fatigue arises at an early duration as a result of increased energy expenditure. The walking pattern becomes circumduction, featured by asymmetry with an extensor synergy of the lower limb. Each step is rotated away from the body then towards the body, forming a semicircle. This leads to changes in various parameters of gait (spatiotemporal, kinematic, and kinetic) in hemiparetic patients. Purpose: Many studies reveal the effectiveness of various therapeutic techniques in managing hemiplegic circumduction gait. Pelvic clock exercises aid in improving pelvic rotation components and cause dissociation in impaired pelvic mobility due to spasticity. A static bicycle helps in enhancing proper control between the hamstrings and quadriceps. It also helps in improving knee flexion range. As the patient places the foot in the cycle’s petals, it helps to enhance dorsiflexion and eversion functions as well. As the lower body is exercised, there could be relative changes in the upper body, i.e., the trunk. Thus, this study aimed to determine the changes in gait functions and trunk performance of chronic ambulatory hemiplegic patients in response to the above therapies for four weeks. Method: Twenty-five subjects (post-stroke duration (2.8 ± 0.6) years) who could walk 10 m independently without assistance or support of aid participated in a pelvic clock and static bicycle exercise intervention. The session duration was 30 min a day, and therapy was delivered six days a week and continued for four weeks. The entire program was carried out in an outpatient neurorehabilitation center. Results: After the intervention with pelvic clock and static bicycle exercises, there was a remarkable change in gait and trunk functions in chronic hemiplegic patients. Conclusion: The exercises comprising pelvic clock and static bicycle showed positive differences in gait and trunk functions in chronic stage hemiplegic patients. Later, randomized controlled studies involving larger sample sizes, advanced activation techniques, and increased intervention duration will explore in-depth information on their effectiveness and clinical significance. Full article

Background and Objectives: Many people tend to carry their bags or baggage on only one side of their body. Due to smartphone use, people also tend to walk bent forward in a kyphotic posture. In this study, we aimed to assess trunk muscle activity changes due to weight-bearing, carried in the left or right hand, and using three different gait postures. Materials and Methods: We recruited 27 healthy participants (aged 19–75 years) with no history of LBP within the last 6 months before study participation. Electromyographic activities of the lower back and the abdominal muscles of the participants were evaluated using four-channel surface electromyography (EMG). Surface EMG recordings were obtained from four trunk muscles, including the flexor (rectus abdominis (RA), external oblique (EO)) and extensor muscles (lumbar erector spinae (LE), and the superficial lumbar multifidus (LM)), during unilateral weight-bearing tasks and with different gait postures (normal gait, with a sway back, and thoracic kyphosis). Results: In the “unilateral weight-bearing task”, there was a significant difference in the activity of all the trunk muscles between the weight-bearing limb side and the opposite side (p < 0.05). The activation of the left trunk muscle was greater than that of the right trunk muscle when the dumbbell was lifted using the right hand. The other side showed the same result. In the “gait posture task” performed by the participants using a sway-back posture, the RA and EO had a higher level of activity in the stance and swing phases compared with that in a neutral gait (p < 0.05). Moreover, in the participants with a thoracic kyphosis posture, the LE and LM had a higher level of activity compared with that in a neutral gait (p < 0.05). Conclusions: Our results indicate that abnormal gait posture and unilateral weight-bearing tasks may impair the balance of trunk muscles, increasing the incidence of LBP. However, further large-scale, prospective, controlled studies are warranted to corroborate our results. Full article

Background: Human T-cell lymphotropic virus type 1 (HTLV-1) infection can be associated with tropical spastic paraparesis (TSP/HAM), which causes neurological myelopathy and sensory and muscle tone alterations, leading to gait and balance impairments. Once trunk perturbation is predicted, the motor control system uses anticipatory and compensatory mechanisms to maintain balance by recruiting postural muscles and displacement of the body’s center of mass. Methods: Twenty-six participants (control or infected) had lower limb muscle onset and center of pressure (COP) displacements assessed prior to perturbation and throughout the entire movement. Results: Semitendinosus (ST) showed delayed onset in the infected group compared to the control group. The percentage of trials with detectable anticipatory postural adjustment was also lower in infected groups in the tibialis anterior and ST. In addition, COP displacement in the infected group was delayed, had a smaller amplitude, and took longer to reach the maximum displacement. Conclusions: HTLV-1 infected patients have less efficient anticipatory adjustments and greater difficulty recovering their postural control during the compensatory phase. Clinical assessment of this population should consider postural stability during rehabilitation programs. Full article

A variety of gait pathologies is seen in cerebral palsy. Movement patterns between different levels of functional impairment may differ. The objective of this work was the evaluation of Gross Motor Function Classification System (GMFCS) level-specific movement disorders. A total of 89 individuals with unilateral cerebral palsy and no history of prior treatment were included and classified according to their functional impairment. GMFCS level-specific differences, kinematics and joint moments, exclusively of the involved side, were analyzed for all planes for all lower limb joints, including pelvic and trunk movements. GMFCS level I and level II individuals most relevantly showed equinus/reduced dorsiflexion moments, knee flexion/reduced knee extension moments, reduced hip extension moments with pronounced flexion, internal hip rotation and reduced hip abduction. Anterior pelvic tilt, obliquity and retraction were found. Individuals with GMFCS level II were characterized by an additional pronounced reduction in all extensor moments, pronounced rotational malalignment and reduced hip abduction. The most striking characteristics of GMFCS level II were excessive anterior pelvic/trunk tilt and excessive trunk obliquity. Pronounced reduction in extensor moments and excessive trunk lean are distinguishing features of GMFCS level II. These patients would benefit particularly from surgical treatment restoring pelvic symmetry and improving hip abductor leverage. Future studies exploring GMFCS level-specific compensation of the sound limb and GMFCS level-specific malalignment are of interest. Full article

Background: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention). Full article

The analysis of the body center of mass (BCoM) 3D kinematics provides insights on crucial aspects of locomotion, especially in populations with gait impairment such as people with amputation. In this paper, a wearable framework based on the use of different magneto-inertial measurement unit (MIMU) networks is proposed to obtain both BCoM acceleration and velocity. The proposed framework was validated as a proof of concept in one transfemoral amputee against data from force plates (acceleration) and an optoelectronic system (acceleration and velocity). The impact in terms of estimation accuracy when using a sensor network rather than a single MIMU at trunk level was also investigated. The estimated velocity and acceleration reached a strong agreement (ρ > 0.89) and good accuracy compared to reference data (normalized root mean square error (NRMSE) < 13.7%) in the anteroposterior and vertical directions when using three MIMUs on the trunk and both shanks and in all three directions when adding MIMUs on both thighs (ρ > 0.89, NRMSE ≤ 14.0% in the mediolateral direction). Conversely, only the vertical component of the BCoM kinematics was accurately captured when considering a single MIMU. These results suggest that inertial sensor networks may represent a valid alternative to laboratory-based instruments for 3D BCoM kinematics quantification in lower-limb amputees. Full article

Background: Improving balance-related ability is an important goal in stroke rehabilitation. Evidence is needed to demonstrate how this goal could be better achieved. Aim: Determine if trunk exercises on unstable surfaces would improve trunk control and balance for persons in the subacute stage of stroke. Design: An assessor-blind randomized controlled trial. Setting: Inpatients in the department of rehabilitation in a general hospital. Population: Patients who suffered a first-time stroke with onset from one to six months. Methods: Inpatients with stroke were assigned to upper limb exercises (control group, n = 17) or trunk exercises on unstable surfaces (experimental group, n = 18) to receive training twice a week for six weeks, in addition to their daily conventional stroke rehabilitation. Sensorimotor function tests, including hand grip, plantar sensitivity, stroke rehabilitation assessment of movement and Fugl-Meyer lower extremity motor scale, and clinical outcome assessments, including Trunk Impairment Scale and 6 m walk test, were conducted before and after six weeks of training. The center of the pressure area while maintaining static posture and peak displacement while leaning forward, as well as the average speed of raising the unaffected arm, were measured in sitting without foot support, sitting with foot support and standing to reflect trunk control, sitting balance and standing balance, respectively. Results: The between-group differences in the sensorimotor functions were nonsignificant before and after training. Compared with the control group, the experimental group had significantly greater forward leaning and faster arm raising in sitting without foot support, higher Trunk Impairment Scale total score, and shorter 6 m walking time after training, but not before training. Conclusion: Trunk exercises on unstable surfaces could further improve trunk control, the ability to raise the unaffected arm rapidly in sitting, and walking for persons in the subacute stage of stroke. This intervention may be considered to be included in stroke rehabilitation. Full article

This study aimed to investigate the effects of speed-interactive pedaling training (SIPT) using a smartphone virtual reality application to improve lower limb motor function, trunk sitting balance, and gait in stroke patients. Forty-two patients who had previously experienced a stroke and could sit independently participated in the study. The subjects were assigned to the SIPT group (n = 21) and the control group (n = 21). The SIPT group had cycle training with SIPT for 40 min a day, five days a week, in a six-week period, in addition to conventional therapy. The control group had cycle training without SIPT and conventional therapy. The Fugl–Meyer Assessment, postural sway, modified functional reach test, trunk impairment scale, and spatiotemporal parameters of gait were used to assess the changes in lower extremity function, the static balance of sitting, the dynamic balance of sitting, and gait ability after the intervention. The Fugl–Meyer Assessment, postural sway, modified functional reach test, trunk impairment scale, and gait ability in the SIPT group were significantly better compared to that of the control group (p < 0.05). Based on this result, we propose that SIPT, which improves function, balance, and gait, could be used as an effective training method to improve patients’ functional activities in the clinical setting. The results of this study suggest that SIPT could be used as an effective training method to restore a patient’s function by improving trunk balance and motor function. Full article

This report describes the modification of hemiplegic shoulder pain and walking velocity through injections of Xeomin®, a new botulinum neurotoxin type A formulation, in a 67-year-old woman with chronic residual left hemiparesis and hemiparetic gait attributable to stroke. Clinical evaluation included upper and lower limb spasticity, upper and lower limb pain, trunk control, upper and lower limb motricity index, visual gait analysis, and gait velocity. Assessments were performed before, 1 week after, and 1 month after treatment. Improvement was observed in all clinical parameters assessed. Amelioration of spasticity of the upper and lower limbs and shoulder pain was observed after 1 month. Trunk postural attitude and paraxial muscle recruitment recovered. No adverse events were observed and the patient shows significant improvement of functional impairment derived from chronic spasticity after treatment with Xeomin®. We also provide a simple and useful protocol for clinical evaluation of the treatment. Full article