Functional Ambulation Scale Research Articles

Effects of motor imagery-based brain-computer interface-controlled electrical stimulation on lower limb function in hemiplegic patients in the acute phase of stroke: a randomized controlled study.

Lower limb motor dysfunction is one of the most serious consequences of stroke; however, there is insufficient evidence for optimal rehabilitation strategies. Improving lower limb motor function through effective rehabilitation strategies is a top priority for stroke patients. Neuroplasticity is a key factor in the recovery of motor function. The extent to which neuroplasticity-based rehabilitation therapy using brain-computer interface (BCI) is effective in treating lower limb motor dysfunction in acute ischemic stroke patients has not been extensively investigated. This study aimed to assess the impact of BCI rehabilitation on lower limb motor dysfunction in individuals with acute ischemic stroke by evaluating motor function, walking ability, and daily living activities. This study was conducted in a randomized controlled trial, involving 64 patients with acute ischemic stroke who experienced lower limb motor dysfunction. All patients were divided into two groups, with 32 patients assigned to the control group was given conventional rehabilitation once a day for 70 min, 5 times a week for 2 weeks, and the experimental group (n = 32) was given BCI rehabilitation on top of the conventional rehabilitation for 1 h a day, 30 min of therapy in the morning and an additional 30 min in the afternoon, for a total of 20 sessions over a two-week period. The primary outcome was lower extremity motor function, which was assessed using the lower extremity portion of the Fugl-Meyer Rating Scale (FMA-LE), and the secondary endpoints were the Functional Ambulation Scale (FAC), and the Modified Barthel index (MBI). After 20 sessions of treatment, both groups improved in motor function, walking function, and activities of daily living, and the improvements in FMA-LE scores (p < 0.001), FAC (p = 0.031), and MBI (p < 0.001) were more pronounced in the experimental group compared with the control group. Conventional rehabilitation therapy combined with BCI rehabilitation therapy can improve the lower limb motor function of hemiplegic patients with stroke, enhance the patient's ability to perform activities of daily living, and promote the improvement of walking function, this is an effective rehabilitation policy to promote recovery from lower extremity motor function disorders.

The effect of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance after stroke: a randomized controlled trial

ABSTRACT Background The goal of post-stroke early rehabilitation is to regain ambulation, standing and balance. Objective The purpose of this study was to investigate the effects of vestibular and somatosensory rehabilitation in addition to early rehabilitation on balance in patients with early subacute stroke. Design and setting A randomized controlled trial was conducted at a university hospital. Methods The study was included 52 hemiplegic hospitalized early suacute stroke patients. The experimental group (n: 30), was applied with vestibular and somatosensorial rehabilitation together with early rehabilitation. Vestibular exercises, included Cawthorne-Cooksey exercises, stimulate the vestibulo-ocular and vestibulo-spinal reflex. Somatosensory exercises, which included Frenkel exercises, stimulate the sensory proprioception and somatosensory systems. The control group (n: 22) patients with early subacute stroke were treated with the early rehabilitation program only. The balance parameters of the patients were evaluated with the Korebalance System, Functional Reach Test, Postural Assessment Scale for Stroke, and Functional Ambulation Scale. Results The mean age of the patients was 67.32 ± 9.46 years, and the mean number of days that had passed since the stroke occurred was 17.90 ± 7.26. In calculating the balance scores, statistically significant differences were observed in the experimental and control groups, with a statistically greater improvement in the rehabilitation group. Statistically significant differences were determined between the groups in respect of the balance scores. Conclusions Based on these findings, the use of vestibular and somatosensory rehabilitation can be recommended for better functioning of the compensatory mechanism of early subacute-stroke hemiplegic patients in early ambulation, and this can lead to considerably improved standing and dynamic upper and lower body balance.

Three-year follow-up outcomes of adult patients with Guillain-Barré Syndrome after rehabilitation.

Guillain-Barré syndrome (GBS), the most common cause of acute paralytic neuropathy, covers a number of recognizably different variants. We aimed to evaluate the clinical characteristics of the patients with GBS and the outcome results of the patients after rehabilitation. We enrolled 24 adult patients with GBS and evaluated their demographic characteristics, signs, complications, functional levels, and residual symptoms at admission, discharge, and during the 1st and 3rd-year follow-up visits. Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Hughes functional grading scale, Six-Minute Walking Test (6MWT), and Fatigue Severity Scale (FSS) were used for patient evaluation. In this study, patients with a mean age of 47.29 ± 16.2 years (40% female) were hospitalized for an average of 28.91 ± 25.6 days. The predominant symptoms experienced by these patients were fatigue (100%), neuropathic pain (70.8%), joint pain (54.2%), and autonomic dysfunction (50%). Significant changes were observed in FIM, Hughes functional grading scale, FAS, 6MWT, and MRC score at admission, discharge, and 1st/3rd-year follow-ups (p=0.000, p=0.000, p=0.000, p=0.001, p=0.000, respectively). Fatigue and Hughes score increased significantly with age (p=0.019, r=0.475; p=0.041, r=0.419, respectively). Negative correlations were found between age and FAS, 6MWT, and MRC score at 1st-year follow-up (p=0.025, r=-0.456; p=0.027, r=-0.450; p=0.008, r=-0.528). FSS was above 4 before admission and in 53.1% at 3rd-year follow-up, correlating negatively with 6MWT and MRC sum score. GBS clinical types showed no significant differences. Rehabilitation improves functional improvement in GBS patients, with long-term benefits observed. However, residual symptoms such as fatigue and neuropathic pain may persist despite functional improvement. These findings highlight the importance of incorporating rehabilitation into the management of GBS and addressing residual symptoms to improve patient outcomes.

Effects of virtual balance training and conservative rehabilitation on balance in chronic stroke patients

Objective: This study aimed to test the comparative efficacy of virtual balance training (VBT) and conservative rehabilitation (CR) relative to CR alone on balance in chronic stroke patients. Methods: Thirty patients with chronic stroke (&gt;6-months post-stroke) were allocated into 2 groups (n=15) as Group CR and Group VBT. CR was performed for 60 min, 4 times a week, for 8 weeks in both groups. VBT was applied for 20 min, 4 times a week, for 8 weeks along with the CR, in Group VBT. Brunnstrom motor recovery (BMR) stage, spasticity degrees, Functional Ambulation Scale (FAS), Short Form-36 (SF-36) scale, Berg Balance Scale (BBS) in both groups were assessed before and after treatment. Mann-Whitney U, Wilcoxon signed rank tests were used to evaluate BBS data (p&lt;0.05). Results: Although, no significant difference was observed between groups in terms of BBS scores, BMR stages, FAS scores, SF-36 scale scores, and spasticity degrees before and after treatment; significant improvements were observed in BBS scores, BMR stages, and FAS scores after treatment in both groups (p&lt;0.05). Comparing the SF-36 subscale scores before and after treatment, significant differences were noted in emotional role limitation scores for Group VBT (p=0.03) and in pain scores for Group CR (p=0.01). Conclusion: VBT along with the CR in chronic stroke patients was not superior to the CR alone, in terms of improving balance, motor recovery, ambulation level, and quality of life.

Fibrofatty filum terminale: long-term outcomes from a Singapore children's hospital.

The role of prophylactic detethering a fibrofatty filum terminale (FFT) remains equivocal. Furthermore, long-term studies focusing on urological outcomes are sparse. The aims of this study were to present an institutional experience on the perioperative and long-term outcomes of FFT surgery and to assess for factors that contribute to postoperative clean intermittent catheterization (CIC). This was a single-institution, retrospective study conducted over a 20-year period. Patients younger than 19 years of age who underwent surgery for FFT were included. Variables of interest included patient demographics, clinical presentation, radiological findings, postoperative complications, and long-term need for CIC. Outcomes were measured using the Necker functional score and modified Hoffer Functional Ambulation scale score at 3, 6, and 12 months postdischarge. A total of 164 surgeries were performed for FFT from 2000 to 2020. The median age at surgery was 1.1 years, and the mean follow-up duration was 8.3 years. There were 115 patients (70.1%) who underwent prophylactic-intent surgery and 49 patients (29.9%) who underwent therapeutic-intent surgery. The proportion of therapeutic-intent surgeries increased significantly with age percentiles (0-20th, 21.9%; 20th-40th, 9.1%; 40th-60th, 18.2%; 60th-80th, 36.4%; and 80th-100th, 63.6% [p < 0.001]). Thirty patients (18.3%) had an associated syndrome, the most common (n = 19, 11.6%) being VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities). Forty-eight patients (29.3%) had an associated malformation (anorectal anomaly = 37, urogenital anomaly = 16, and sacral anomaly = 3). Cutaneous manifestation was the most common presentation (n = 96, 58.5%), followed by lower-limb neurological deficits (n = 21, 12.8%). A low-lying conus was present in 36.0% of patients (n = 59), and 16.5% had an associated syrinx (n = 27). There were 26 patients (18.8%) with an abnormal preoperative urodynamic study. Three patients (1.8%) had postoperative complications that required repeat surgery. There were no cases of CSF leakage. One patient (0.6%) developed retethering requiring another surgery. Postoperative CIC was required in 11 patients (6.7%). Multivariable analyses showed that an abnormal preoperative urodynamic study (adjusted OR 5.5 [95% CI 1.27-23.9], p = 0.023) and having an intraspinal syrinx (adjusted OR 5.29 [95% CI 1.06-26.4], p = 0.042) were associated with the need for CIC. The authors' results demonstrate that detethering surgery for FFT is a relatively safe procedure and can be performed prophylactically. Nonetheless, the risks of postoperative CIC should be emphasized during the preoperative counseling process.

GECİKMİŞ TANI İLE TEDAVİ EDİLMEYEN GERİATRİK FENİLKETONÜRİ: ICF TEMELLİ BİR VAKA RAPORU

Purpose: Due to the nature of the phenylketonuria (PKU), it is difficult to categorize these patients' needs in a treatment management. The aim of this study was to evaluate an untreated geriatric PKU patient based on International Classification of Functioning, Disability and Health (ICF).&#x0D; Method: The 72-year-old patient was presented with late-diagnosed and untreated PKU during his lifetime. The body structure and functions of the patient were determined by the Tinetti Scale, Sit-up test for 30-second, The Upper Extremity Index, Barthel Daily Life Activity Scale, Short Form- 36 Quality of Life scales were used to determine activities and limitations. Functional Ambulation Scale and Barthel Index were used for assessing participation.&#x0D; Results: In this case, physical disabilities caused problems in his self-care and participation in life accompanying with cognitive problems, environmental and personal factors are negatively affecting his quality of life.&#x0D; Conclusion: Many aspects of the geriatric PKU's participation in life and the parameters that need to be evaluated remain uncertain. For this reason, we suggest that healthcare professionals working with individuals with geriatric PKU patients might follow the ICF qualifiers and assessment methods as in this case report.

Frequency of Central Post-Stroke Pain and Its Impact on Quality of Life

Objective: This study aims to determine the frequency of central post-stroke pain (CPSP) in a patient population with stroke as well as investigating the relationship between CPSP and patients' clinical/demographic characteristics, pain intensity, functional status, and quality of life.&#x0D; Methods: The study included 150 patients, who had a stroke and were aged 18 years and above. Demographic data of the patients, time since onset, and etiology, localization of the cerebral lesion, affected side, ambulation status, and Brunnstrom stages were recorded. Douleur neuropathique 4 questions (DN4) were used to assess the presence of CPSP. Visual Analog Scale (VAS) was used for pain intensity, functional ambulation scale (FAS) was used for ambulation status, Barthel Index (BI) was used for functional status, and the stroke impact scale (SIS) was used for quality of life.&#x0D; Results: The mean age of the patients was 67±11.5 years, 54.7% was male, and 45.3% was female. CPSP was evaluated in 15.3% of patients. There was no significant difference between the affected side of the body and age, gender, time since onset, BI scores, and ambulation status of patients according to their CPSP status (p&gt;0.05). There was no statistically significant difference between SIS sub-parameter scores and the presence of CPSP (p&gt;0.05). In correlation analysis, a significant relationship was found between Barthel Indexes and all SIS domains except memory and emotion (p

REHABILITATION RESULTS OF PATIENTS WITH COVID-19 RELATED STROKE

The aim of the study is to examine the patients with COVID-19 associated stroke who were admitted to the inpatient rehabilitation program in terms of clinical features, ambulation level and functional status, and to reveal the improvements achieved as a result of rehabilitation. 29 COVID-19-related stroke patients (group 1) and 29 non-COVID-19 stroke patients (group 2) were included in this study. The groups were compared in terms of demographic and clinical characteristics, risk factors, post-stroke disorders and complications of stroke. Motor function was evaluated with the Brunnstrom Motor Recovery Staging (BMRS), ambulation status was evaluated with the Functional Ambulation Scale (FAS), and functional disability was evaluated with the Functional Independence Scale (FIM). Both groups of patients were compared in terms of pretreatment and posttreatment values of BMRS, FIM and FAS stages. In addition, the changes in BMRS, FIM and FAS values within the group were evaluated. Pulmonary involvement (mild/moderate-severe) and the use of anticoagulants after COVID-19 infection were investigated in patients with COVID 19 stroke. In patients with COVID-19-associated stroke, the mean age was statistically significantly lower (p=0.045), the risk factor hypertension was significantly less (p=0.016), pre-stroke anticoagulant use was significantly higher (p=0.004), and deep vein thrombosis was significantly higher (p=0.022). All patients with COVID-19 had pulmonary involvement. No statistically significant difference was observed between the two groups in the comparison of post-stroke disorders. There was no statistically significant difference between the two groups in terms of BMRS, FIM and FAS values before and after treatment (p&gt;0.05). The change in BMRS, FIM and FAS values within both groups was found statistically significant. According to the results of this study, COVID-19-related stroke is seen at younger ages and deep vein thrombosis is more common. Significant improvements are observed in motor and functional status after rehabilitation. Rehabilitation should be given importance in patients with COVID-19-related stroke, and care should be taken in terms of deep vein thrombosis during rehabilitation.

The Relationship Between Urinary Symptom Severity And Functional Status İn Patients With Stroke.

Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state. To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status. 77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings. The mean CLSS of men was significantly higher than women (P = 0.017). A significant positive correlation was found between age and CLSS (P = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS (P = 0.001 r = -0.467). LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.

Efficacy of a Novel Exoskeletal Robot for Locomotor Rehabilitation in Stroke Patients: A Multi-center, Non-inferiority, Randomized Controlled Trial.

Objective: To investigate the efficacy and safety of a novel lower-limb exoskeletal robot, BEAR-H1 (Shenzhen Milebot Robot Technology), in the locomotor function of subacute stroke patients.Methods: The present study was approved by the ethical committee of the First Affiliated Hospital of Nanjing Medical University (No. 2019-MD-43), and registration was recorded on the Chinese Clinical Trial Registry with a unique identifier: ChiCTR2100044475. A total of 130 patients within 6 months of stroke were randomly divided into two groups: the robot group and the control group. The control group received routine training for walking, while in the robot group, BEAR-H1 lower-limb exoskeletal robot was used for locomotor training. Both groups received two sessions daily, 5 days a week for 4 weeks consecutively. Each session lasted 30 min. Before treatment, after treatment for 2 weeks, and 4 weeks, the patients were assessed based on the 6-minute walking test (6MWT), functional ambulation scale (FAC), Fugl-Meyer assessment lower-limb subscale (FMA-LE), and Vicon gait analysis.Results: After a 4-week intervention, the results of 6MWT, FMA-LE, FAC, cadence, and gait cycle in the two groups significantly improved (P < 0.05), but there was no significant difference between the two groups (P > 0.05). The ratio of stance phase to that of swing phase, swing phase symmetry ratio (SPSR), and step length symmetry ratio (SLSR) was not significantly improved after 4 weeks of training in both the groups. Further analyses revealed that the robot group exhibited potential benefits, as the point estimates of 6MWT and Δ6MWT (post-pre) at 4 weeks were higher than those in the control group. Additionally, within-group comparison showed that patients in the robot group had a significant improvement in 6MWT earlier than their counterparts in the control group.Conclusions: The rehabilitation robot in this study could improve the locomotor function of stroke patients; however, its effect was no better than conventional locomotor training.

The relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy.

Objectives The aim of this study was to investigate the relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy (DMD). Patients and methods Between January 2018 and July 2018, a total of 55 patients (54 males, 1 female; mean age: 9.9±2.9 years; range, 6 to 15 years) who were diagnosed with DMD based on the clinical, laboratory, muscle biopsy and molecular analysis results were included in this cross-sectional study. Scoliosis was evaluated and Cobb angles were measured. Functional Ambulation Scale and Brooke and Vignos scale scores were recorded. The ABILHAND-Kids questionnaire and Nine-Hole Peg Test (9-HPT) were used to assess the upper extremity functions. Hand grip strengths were also evaluated. Results The median ABILHAND-Kids scores and the hand grip strength values of the patients without scoliosis were significantly higher compared to those with scoliosis (p=0.002 and p=0.004 for right hand and p=0.012 for left hand, respectively). There was no statistically significant difference in the 9-HPT scores between the patients with and without scoliosis (p>0.05). We found a negative, significant correlation between the Cobb angle and ABILHAND-Kids scores in patients with scoliosis (r=-0.503; p=0.017). Conclusion Our study results show a moderate relationship between scoliosis and upper extremity functions. Scoliosis may adversely affect upper extremity functions in patients with DMD.

The efficiency of mirror therapy on drop foot in Multiple Sclerosis Patients.

Although the effectiveness of mirror therapy (MT) has been proved in stroke persons, there is no scientific evidence about the results in people with multiple sclerosis. The aim was to investigate whether adding MT to exercise training and neuromuscular electrical stimulation (NMES) has any effect on clinical measurements, mobility, and functionality in people with multiple sclerosis (MS). Ambulatory people with MS, with unilateral drop foot, were included. MT group (n=13) applied bilateral ankle exercise program with mirror following NMES for 3days a week at hospital and exercise program for 2days a week at home. Control group (n=13) performed same treatment without mirror box (6weeks). The later 6weeks both groups performed only exercise program. Clinical measurements included proprioception, muscle tone of plantar flexor muscles (MAS), muscle strength of dorsiflexor, ankle angular velocity, and range of motion (ROM) of ankle. Functionality (Functional Independence Measurement-FIM), mobility (Rivermead Mobility Index-RMI), ambulation (Functional Ambulation Scale-FAS), duration of stair climb test, and 25-foot walking velocity were assessed at the beginning, in 6th and 12th weeks. More positive improvements were obtained in MT group than control group in terms of range of motion (0.012), muscle strength (0.008), proprioception (0.001), 25 feet walking duration (0.015), step test duration (0.001), FAS (0.005), RMI (0.001), and FIM (0.001) after 6weeks treatment. It was seen that this improvement maintained to 12th week on all clinical and functional measurements (p<.05). The trial revealed that adding MT to exercise training and NMES has more beneficial effects on clinical measurements, mobility, and functionality in people with multiple sclerosis with unilateral drop foot.

Is comorbidity related to the independence of patients with spinal cord injury?

Aim: Apart from the complications of spinal cord injury, some comorbidities in patients with this injury should be considered in the long term. In this study, we aimed to identify the comorbidities in patients with chronic spinal cord injury and the relationship of these comorbidities with the patients’ level of independence.Methods: This retrospective cohort study involved 40 patients who had spinal cord injury and were admitted to an inpatient rehabilitation program at our hospital between March 2014 and January 2016. The participants were evaluated in terms of age, height, weight, body mass index, place of residence, and marital status. Their type, level, and duration of injury were also assessed. ASIA Impairment Scale (AIS), Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Spinal Cord Independence Scale (SCIM), and Cumulative Illness Rating Scale (CIRS) were used to evaluate the patients.Results: The mean age of the 40 patients with chronic spinal cord injury was 41.83 (16.87) years. Their most common comorbidities were genitourinary (62.5%), lower gastrointestinal (50%), and ophthalmological–otolaryngologic problems (42.5%). No correlation was found between the CIRS scores and the SCIM Personal Care, Respiratory and Sphincter Management, Mobility, and the total SCIM scores of the participants. (P=0.949, P=0.469, P=0.452, P=0.521, respectively). By contrast, the FIM scores were correlated with the SCIM scores of the cases (P=0.014).Conclusion: The most common long-term comorbidities in patients with spinal cord injury were genitourinary, lower gastrointestinal, and ophthalmological–otolaryngologic problems. However, these comorbidities were not directly related to the patients’ ambulation and independence levels.

Poor Sleep Quality I Related to Impaired Functional Status Following Stroke

Introduction: Sleep disorders are more prevalent in patients with previous stroke compared to healthy individuals. The main objective of the present study was to investigate the impact of sleep quality on the functional status of patients with a history of stroke, upon admission to inpatient rehabilitation. Methods: Fifty patients (mean age: 69 ± 11 years) with previous stroke were consecutively included in this single center cross-sectional observational study upon admission to inpatient rehabilitation. Pittsburgh Sleep Questionnaire Index (PSQI) was calculated for all patients and patients were divided into 2 groups according to PSQI scores (PSQI ≤ 5 as good sleepers and PSQI > 5 as poor sleepers). A specialist evaluated the level of muscle spasticity and disability, walking capability, and overall performance of daily activity of all enrolled patients using the functional ambulation scale (FAS) score, modified Brunnstrom Classification, Modified Ashworth scale, and Beck Depression Inventory. Results: The FAS score (3.4 ± 1.3 versus 1.8 ± 1.7, P = .004) and Brunnstrom scores of upper limb (3.8 ± 1.1 versus 2.5 ± 1.6, P = .005), lower limb (4.3 ± 1.4 versus 3.1 ± 1.7, P = .013) and hand (3.6 ± 1.5 versus 2.3 ± 1.6, P = .006) were significantly higher in good sleepers than poor sleepers. Linear regression analysis revealed that PSQI score (coefficient β = −.360, 95% CI: −.212-.032, P = .009) and age (coefficient β = −.291, 95% CI: .100-.245, P = .032) were independently associated with FAS score. Conclusion: Results of the present study indicate that presence of poor sleep quality is associated with poor functional status which might further impair the outcomes of the rehabilitation and accordingly the health-related quality of life in patients admitted for stroke rehabilitation.

Physical activity and sedentary behaviour in children with spina bifida.

To describe active and sedentary time in children with spina bifida and to compare their physical activity on weekdays versus weekends. In this exploratory cross-sectional study, data from 13 Canadian and 22 Dutch children with spina bifida (14 females, 21 males; mean age 10y 11mo, standard deviation [SD] 3y 6mo, range 5y 6mo-18y; Hoffer classification distribution: community [n=28], household [n=3], non-functional [n=3], and non-ambulator [n=1]) were analysed. Objective measures of physical activity and sedentary behaviour were obtained by using ActiGraph or Actiheart activity monitors. Data for the participants wearing the ActiGraph were compared with age- and sex-matched controls that were developing typically using independent-samples t-tests. Activity data collected on weekdays was compared to those on weekends. ActiGraph data demonstrated children with spina bifida spent more time sedentary (mean [SD] 49.5min/h [5.78]) and less time in moderate to vigorous physical activity (mean [SD] 2.33min/h [1.61]) compared with the typically developing group (mean [SD] 41.0min/h [5.76] and 5.46min/h [2.13], p=0.001 and p<0.001 respectively). For both ActiGraph- and Actiheart-derived data, physical activity and sedentary time were not significantly different between weekdays and weekends. Children with spina bifida have reduced levels of physical activity and increased sedentary behaviour, with no statistical differences seen between weekdays and weekends. Several methodological issues related to activity monitoring warrant consideration when choosing the appropriate method to quantify physical activity and sedentary behaviour. Reduced levels of physical activity and sedentary time were quantified in children with spina bifida. Objective quantification of physical behaviour in ambulatory and non-ambulatory school-aged children with spina bifida is possible.

Ultrasonographic and electrophysiologic evaluation of median and ulnar nerves in chronic stroke patients with upper extremity spasticity

Objective: To evaluate the upper extremity nerves of stroke patients morphologically and electrophysiologically and to determine whether there is a relationship between clinical evaluations, ultrasonographic measurements, and electrodiagnostic findings.Methods: This cross-sectional study included 30 chronic stroke patients. After recording demographical data, clinical, ultrasonographic, and electrophysiological evaluations were performed. Clinical evaluations included Brunnstrom Recovery Stages (BRS), Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motricity index (MI), Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS). For ultrasonographic measurements, median and ulnar nerves were scanned. Median and ulnar nerve conduction studies were performed bilaterally.Results: Mean ages of the patients were 62.2 ± 13.0 years (range 24–84 years; 22 males, 8 females). There was no significant difference in median/ulnar nerve ultrasonographic measurements between paretic and non-paretic sides (p > .05), whereas median nerve motor conduction velocity was significantly slower and median nerve F-wave latency was prolonged on the paretic side (p < .05). The median and ulnar nerve compound motor action potential (CMAP) amplitudes of paretic sides were positively correlated with lower extremity BRS and FAS scores. Median CMAP amplitudes were also positively correlated with FIM scores and ulnar CMAP amplitudes were positively correlated with motricity scores. Moreover, on the paretic side, there were positive correlations of median SNAP amplitudes with FIM and FAS scores (p < .05).Conclusions: Our results showed electrophysiological changes in peripheral nerves on the paretic upper extremities, however, no morphological change was determined. Further studies with larger number of patients and longer follow-up periods are needed to clarify the effect of stroke and spasticity on the peripheral nervous system.

Recovery of gait function with a wearable powered exoskeleton in sub-acute stroke patients using SEMG for fine tuning: Preliminary results

Gait recovery in post-stroke patients is one of the main goals of post-stroke rehabilitation. Wearable over-ground powered exoskeletons allow individuals with gait dysfunctions to perform an over-ground gait training. Literature lacks of clinical studies on exoskeleton-supported gait rehabilitation in stroke patients and on setting modalities. Ekso is a wearable exoskeleton equipped with 4 motors, which allows the patient to stand up, sit and walk on a flat hard surface. The aim of this study is to investigate the clinical effects of an over-ground walking training with a wearable powered exoskeleton (Ekso), after a sEMG fine tuning, in sub-acute stroke patients. This is a pilot pre-post, open label, non randomized, non controlled experimental study. 47 sub-acute stroke patients underwent a walking rehabilitation training of 15 sessions (60 min/session, 3 times/week) using Ekso. A surface electromyography (sEMG) of rectus femoris, hamstrings, tibialis anterior and soleus of both limbs was collected in order to define the best setting for each patient. Clinical evaluation was performed at the beginning of the training period (t1), and after 15 sessions (t2) using: Barthel Index, Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10 meter walking test, 6 minutes walking test, and Walking Handicap Scale. Wilcoxon's tests ( P < 0.05) was used to detect significant changes between data. Significant statistical improvements were found between t0–t2 in Barthel Index, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10 meter walking test, and 6 minutes walking test. Fifteen sessions of over-ground gait training using a powered wearable robotic exoskeleton, set with sEMG, improve ambulatory functions in sub-acute post-stroke patients. Further studies are needed to better understand the treatment effect.

A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients.

[Purpose] To investigate the effect of vitamin D supplementation on rehabilitation outcomes and balance in patients having hemiplegia due to ischemic stroke. [Subjects and Methods] Vitamin D levels of 132 patients hospitalized for hemiplegia rehabilitation due to ischemic stroke were tested. Consequently, 86/132 patients had low vitamin D levels, 72 of which met the inclusion criteria and were included in the study. Patients were divided into two groups: Group A (injected with 300,000 IU vitamin D), and Group B (injected intramuscularly with saline). Each patient was tested at the baseline and at the third month using the Brunnstrom recovery staging, functional ambulation scale, modified Barthel index, and Berg balance scale. The findings were compared between the groups. [Results] By the end of the third month, The Berg balance scale results and modified Barthel index scores significantly differed between the two groups, whereas Brunnstrom recovery staging and functional ambulation scale test results did not. [Conclusion] This study found that vitamin D administration increased the activity levels and accelerated balance recovery but did not significantly affect ambulation or motor recovery. These results warrant confirmation by longer follow-up studies with a larger number of participants.

Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial

Background: Repetitive transcranial magnetic stimulation (rTMS) was suggested as a preconditioning method that would increase brain plasticity and that it would be optimal to combine rTMS with intensive rehabilitation.Objective: To assess the efficacy of inhibitory rTMS on upper extremity motor recovery and functional outcomes in chronic ischemic stroke patients.Methods: In this randomized controlled trial, experimental group received low-frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT), and control group received PT.Results: No statistically significant difference was found in baseline demographical and clinical characteristics of the subjects including stroke severity or severity of paralysis prior to intervention. There were statistically significant improvements in all clinical outcome measures except for the Brunnstrom Recovery Stages. Fugl–Meyer Assessment, Box and Block test, motor and total scores of Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS) scores were significantly increased in both groups, however, these changes were significantly greater in the rTMS group except for FAS score. FIM cognitive scores and standardized mini-mental test scores were significantly increased and distal and hand Modified Ashworth Scale scores were significantly decreased only in the rTMS group (p < .05).Conclusions: LF-rTMS can safely facilitate upper extremity motor recovery in patients with chronic ischemic stroke. TMS seems to be a promising treatment for motor, functional, and cognitive deficits in chronic stroke. Further studies with a larger number of patients with longer follow-up periods are needed to establish its effectiveness in stroke rehabilitation.

Assessment of the Anterior Talofibular Ligament Thickness in Patients with Chronic Stroke: An Ultrasonographic Study

BackgroundPatients with equinovarus deformity have an increased risk of fall and ankle ligament injury, because of inappropriate prepositioning of the ankle at the end of the swing phase, and inadequate leg and ankle stability during the stance phase. Accordingly, the aim of this study is to compare anterior talofibular ligament (ATFL) thickness of chronic stroke patients with that of healthy individuals using ultrasonography. MethodsThis was a case-control study conducted in a university hospital between July 2015 and July 2016. We included 38 patients [study group; mean age, 59.0±11.1 years; mean body mass index (BMI), 25.4±4.3 kg/m2] and a control group of age-, sex-, and BMI-matched healthy individuals. Demographic and clinical characteristics of the patients (i.e., age, weight, height, Brunnstrom motor recovery stage, Functional Ambulation Scale, Ashworth Scale, and duration of hemiplegia) were recorded during their visits. Furthermore, ultrasound image of the ATFL was obtained from each ankle. The thickness of the ATFL was measured at the midpoint of the ligament between the attachments on the lateral malleolus and the talus using ultrasonography. ResultsIn the study group, the mean thickness of the ATFLs of the affected side (2.75±0.41 mm) was thicker than both the unaffected side (2.42±0.30 mm) and the healthy controls (2.35±0.19 mm; p=0.007, p<0.001, respectively). No differences were seen between the two sides of the control group. ConclusionChronic stroke patients have a thicker ATFL on both the affected and unaffected sides, compared with healthy individuals. This architectural feature of the ATFL may be a result of equinovarus deformity together with spastic muscles. For this reason, early treatment of deformed ligaments and spastic muscles is needed to prevent equinovarus deformity in patients with stroke.