Hemiplegic Persons Research Articles

Effects of H-Reflex Onset Latency on Gait in Elderly and Hemiplegic Individuals.

Background and Objectives: The Hoffmann’s reflex (H-reflex) is important in electrodiagnostic testing because it improves sensitivity and specificity in diagnosing radiculopathies. Although quantitative electromyography (EMG) measurements for H-reflex amplitudes during the gait cycle have been performed in both hemiplegic and healthy individuals, research on the H-wave latency in these individuals during the gait cycle is lacking. Materials and Methods: The H-reflex latency of the soleus muscle was investigated in hemiplegic stroke patients and healthy elderly persons in this observational analytical study. Two groups of individuals participated in this study: healthy adults (n = 25) and stroke patients with hemiplegia (n = 25) were compared. An MP150 with Ag-Ag/Cl electrodes was utilized to record and analyse electromyography measurements. All individuals could walk independently indoors. Stimuli were administered to elicit the H-reflex in the four gait phases as the participant walked. Results: Stroke patients had a significantly shorter latency than did healthy patients in the mid-swing, mid-stance, and toe-off phases of the gait cycle; heel-strike latency did not significantly differ. Conclusions: These results can be used as diagnostic data to help account for patient characteristics or measure the recovery extent for treatment planning and gait training in hemiplegic individuals.

Development of pneumatic artificial muscle type active ankle foot orthosis capable of assisting depending on the walking phase

Many ankle foot orthoses have been developed to assist the hemiplegic person in walking, but most of them are passive orthoses that can perform the necessary auxiliary functions only in a specific phase during walking. Therefore, we have developed an active ankle foot orthosis that divides the walking cycle into four phases by measuring the ground contact of the heel and the ball of the finger with a pressure sensor, and can set ankle plantar dorsiflexion motion assist depending on the phase.

The effectiveness of virtual reality therapy in relieving upper limb hemiparesis after stroke: A meta-analysis of randomized and controlled trials

Objective To analyze the clinical efficacy of using virtual reality (VR) to improve the upper limb function of hemiplegic persons. Methods A search was conducted in the PubMed, Cochrane Library, EMBASE, CNKI and Wanfang Data as well as VIP for reports of randomized and controlled studies of using VR in training upper limb function after stroke. A meta-analysis was then performed using version 5.3 of the Review Manager software. Results Ninety studies involving 879 patients were found and analyzed. The data showed that VR was significantly more effective than conventional training in improving Fugl-Meyer assessment scores. It was not superior, however, in improving average Functional Independence Measure scores or performance in the box and blocks test. Conclusion VR is superior to conventional training in promoting the recovery of upper limb function after a stroke. Key words: Stroke; Hemiplegia; Virtual reality; Upper extremities; Meta-analyses

Standing at a table while training improves the upper limb function of hemiplegic stroke survivors

Objective To explore the effect of standing at a table while training on the upper limb function and muscle surface electromyography of hemiplegics. Methods Sixty hemiplegic persons were randomly divided into an experimental group and a control group, each of 30. The affected upper limbs of the experimental group were trained while standing at a table, while the control group was trained while sitting. Before the treatment, as well as after 2 and 4 weeks of treatment, both groups′ motor functioning was evaluated using the Fugl-Mayer upper limb assessment (FMA), as well as muscle surface electromyography. Results Before the treatment there was no significant difference between the two groups′ average FMA scores. After 2 and 4 weeks of treatment it had increased significantly in the experimental group, but in the control group the increase was not significant until the fourth week. In terms of surface myography, significant differences were observed in the biceps femoris and gastrocnemius muscles of both groups after 2 weeks. Two weeks later there was further significant improvement in both groups except for the tibialis anterior muscles of the control group. The differences between the two groups were significant after two weeks in the electromyograms of the biceps femoris, gastrocnemius muscle and anterior tibialis. After four weeks the differences between the groups in all of the electromyograms were significant. Conclusion Compared with the traditional sitting position, standing at a table while training can effectively improve the muscle activity of the rectus abdominis and the spine so as to promote the recovery of movement in hemiplegic upper limbs. Key words: Standing; Cerebral infarction; Hemiplegia; Dysfunction; Occupational training; Surface electromyography

Key function for obstacle crossing in hemiplegic persons with varied degrees of spasticity.

[Purpose] To evaluate various key functions related to obstacle crossing motions in hemiplegic people based on the paralysis degree. [Subjects and Methods] Thirty-seven patients with maintenance-stage hemiplegia who could independently ambulate outdoors were included. Subjects’ crossing movements were measured using obstacles with heights of 10%, 20%, and 30% of the trochanter length. The relationship among maximal crossing height and isometric knee extension muscle strength, one leg standing time, Trunk Impairment Scale score, disease duration, and subject age was examined, as was the target variable of maximum crossing height and the top four measurement items, to determine the explanatory variables. The participants were grouped based on Brunnstrom Recovery Stages III–IV (severe spasticity) and V–VI (mild spasticity). [Results] The explanatory variables were the Trunk Impairment Scale in the severe spasticity group and unaffected side-knee extension muscle strength in the mild spasticity group (contribution rates: 75.6% and 21.0%, respectively). [Conclusion] Trunk function in the severe spasticity group majorly contributed to crossing obstacles. Furthermore, knee extension muscle strength on the unaffected side in the mild spasticity group moderately contributed to crossing obstacles. Selecting and implementing a physical therapy routine that is aimed at improving function, depending on the severity of paralysis, is necessary.

1A1-I10 RGB-Dセンサを用いた障碍者の状態推定システムの開発 : 複数RGB-Dセンサを用いた動作計測

In this study, to support handicapped people, especially focusing on a hemiplegic person, a life support system is proposed. For improving their QoL, the system is required to support their early rehabilitation rather than care for whole ADLs. Therefore, we propose a system, which measures and estimates a state or a condition of a patient using multiple RGB-D sensors. In the system, by calculating angle and estimating position of each joints, the Brunnstrom stage of patient is estimated based on a method proposed by Ueda. On the other hand, in the case of measurement using only a RGB-D sensor, some joints are occluded by the other objects and their positions are not able to be estimated. In this paper, to avoid occlusions, a way of measurement a motion of patients using multiple RGB-D sensors is described.

1P2-L03 上肢下肢運動シナジーに基づく装着型ロボット制御法の臨床適用

In this paper we present the first clinical application of a newly developed control method for wearable lower limbs exoskeleton robots. The method we developed is one based on using body joint synergetic effect, with a walking aid cane, to estimate and provide assist on the affected limb(s). The outcome of hemiplegic persons walking with the system shows the subjects immediately being able to walk with the system, and improvements in some gait aspects. This investigation exhibits the clinical applicability of the proposed method, and prospective gait function improvements of using the system. The finding contributes to the technology for cognitively assisted locomotion, which helps the locomotion of physically challenged people.

Effects of the ankle foot orthosis functions for plantar flexion on gait of hemiplegic persons : analysis according to gait pattern

Effects of the ankle foot orthosis functions for plantar flexion on gait of hemiplegic persons : analysis according to gait pattern

A distributed three-channel wireless Functional Electrical Stimulation system for automated triggering of stimulation to enable coordinated task execution by patients with neurological disease

Functional Electrical Stimulation (FES) is a technique used to improve mobility and function for patients suffering some neurological related diseases such us Multiple Sclerosis (MS) and stroke. Some patients might require FES applied in more than one location depending on the extent of the neurological condition. Currently, this can be achieved using multi-channel FES systems. However, these systems can be bulky and impractical in daily usage. This research investigates using a wireless distributed FES system to overcome some of the limitations of the current multi-channel systems. A prototype of a three-channel FES system was built and tested. The prototype is used for drop foot stimulation and reciprocal arm swing stimulation while the user is walking, and for elbow extension and wrist/fingers opening stimulation if triggered while standing or sitting. A pilot study was designed to evaluate the reliability and repeatability of the system with 11 healthy volunteers without applying stimulation. This was followed by a case study with a hemiplegic person. The results indicate that the system can successfully detect and generate output responses appropriate to the input signals from the body sensors.

Comprehensive rehabilitation course in adult hemiplegia: evaluation value, the PMIC

Rehabilitation has a threefold problem regarding hemiplegia: the first is how to handle the single case to obtain the best result; second is to have a set of structures that allows follow up for the hemiplegic person in the whole rehabilitative course, step by step, phase by phase, according to his needs; third is to verify the reality of rehabilitative intervention. To face the first and the second problem, post-acute clinic, intensive or extensive, outpatients departments, and the possibility “in-home” treatments are needed. A web of structures of different types is needed, working one after the other to avoid that “therapeutic lack” which causes more damage than the pathological event itself, or the advantages of hard rehabilitative work, for the patient, his family and the rehabilitative team, disappears. For this reason, knowing if, when, where to start, to continue or to stop a rehabilitative course is extremely important and this can only be realized through a valid way of evaluation supporting scientific knowledge and clinic experience. In the acute phase, a correct evaluation allows the definition of the best prognosis, the choice of the possible outcomes and the best setting in which to reach them. In the same way, the evaluation skill will enable the decision of when, where and how to continue the rehabilitative intervention or if consider it ended. To face the third problem, an appropriate system of scales on which a series of evaluations can be founded is needed. We all know that and so we use a scientific validated system of evaluation. PMIC, proposed by SIMFER first and then accepted and proposed to its member by SIRN also, comes in this context with a particular value: to offer an identical basic evaluation protocol to all the users. This protocol, studied with scientific accuracy, is divided in three sections as the three phases of evolution of the problem: acute phase (utilized during the hospital period in acute departments); confinement rehabilitative phase; territorial rehabilitative phase. Knowing this population data could allow a more correct setting with no waste; plus it could allow the evaluation of the real efficacy of rehabilitative interventions and the real need of a social rehabilitative intervention on the residual impairment. Working group SIMFER-SIRN on PMIC in Calabria has a good experience on this protocol.

Modulation of the withdrawal reflex during hemiplegic gait: Effect of stimulation site and gait phase

Objective The objective of the study was to investigate the sensitivity of the nociceptive withdrawal reflex to stimulation of different locations on the sole of the foot during hemiplegic gait. Methods Reflexes were evoked by cutaneous electrical stimulation of 4 locations on the sole of the foot of 7 hemiplegic and 6 age-matched healthy persons. The stimuli were delivered at heel-contact, during foot-flat, at heel-off, and during mid-swing. Reflexes were recorded from muscles of the stimulated and the contralateral leg. Ankle, knee, and hip joints angles were recorded using goniometers. Results In the hemiplegic persons, the size of tibialis anterior reflexes, and the latency of soleus reflexes were site- and phase-modulated. In both groups, the tibialis anterior reflexes were significantly smaller with stimulation to the fifth metatarsophalangeal joint and the heel compared with the first metatarsophalangeal joint and the arch of the foot. The tibialis anterior reflexes evoked at heel-off and mid-swing were larger in hemiplegic persons than in healthy persons. Reflexes in the proximal and contralateral limb muscles were not site-modulated during hemiplegic gait. The kinematic response at the ankle joint was also different in the two groups during mid-swing. Conclusions Hemiplegic and healthy middle-aged people presented different phase-modulation of the kinematic and muscle nociceptive reflex responses evoked by stimulation delivered on the sole of the foot. Significance The results have potential application in programs to rehabilitate hemiplegic gait.

Bridging activity as a mode of stress testing for persons with hemiplegia

Objective: To establish a stress testing protocol for hemiplegic persons using graded bridging activity at the rates of 3 to 24 repetitions per minute. Design: Paired comparisons of exercise parameters and admission and discharge data between hemiplegic and control groups. Setting: Inpatient rehabilitation program of a tertiary rehabilitation center in Japan. Patients: (1) Preliminary study: five hemiplegic patients. (2) Comparison with normal subjects: 39 hemiplegic patients and 10 age-matched controls. (3) Study of reproducibility: five hemiplegic patients and five controls. (4) Longitudinal changes: 30 hemiplegic patients. Main Outcome Measures: Oxygen consumption (V̇o 2), heart rate (HR), and HR oxygen coefficient (regression coefficient between HR and V̇o 2). Results: The testing protocol was applicable to 88.6% of hemiplegic patients. The relationship between HR and V̇o 2 was linear, and HR oxygen coefficient was significantly lower in hemiplegic patients than the controls. The intraclass correlation coefficients were greater than 0.7 for V̇o 2, HR, and HR oxygen coefficient, indicating satisfactory reproducibility. HR decreased longitudinally for the same stress levels and the HR oxygen coefficient increased, indicating improved fitness level. Conclusions: The bridging activity protocol is a useful mode for stress-testing hemiplegic persons. The linearity between HR and V̇o 2 with this protocol allows us to use the indices of fitness obtainable from this relationship.

Relations between biased tonicity of the body and vertical judgement in poststroke hemiplegic persons.

The influence of muscular tension upon visual vertical judgement in a standing posture was investigated in 16 hemiplegic persons and 12 normal elderly persons. The normal elderly group showed that their judgements of verticality were accurate and stable. In hemiplegic persons, judgements were displaced opposite to the side in which there was high tension in the body. Differences between groups in body tension and the side to which judgement was displaced were significant. The peculiar judgement errors made by hemiplegic persons are thus an overcorrection for tonicity. It was related to one's own body perception.

Quantifying lateral pelvic displacement during walking

Objective. The purpose of this investigation was to test a new procedure for quantifying lateral pelvic displacement during walking. Design. A quasi-experimental design was used to quantify the gait of 18 unimpaired people and one person with hemiplegia. Background. Although previous techniques provided useful information on amplitude of lateral pelvic displacement, they did not consider step-to-step variations in walking direction or enable quantification of symmetry. Methods. Three-dimensional motion analysis was used to collect the coordinates of light-reflective markers placed on the scarum and heels of each subject. Subjects performed one 10 m overground walk at their preferred speed. Amplitude and symmetry of lateral pelvic displacement were quantified relative to the step-to-step variation in the path of motion (base of support). Results. The mean amplitude of lateral pelvic displacement for the unimpaired group was 40.8 mm, and symmetry was 3.1 mm. The amplitude of lateral pelvic displacement for the hemiplegic person was 88.4 mm. Symmetry was 30.9 mm, with deviation toward the non-paretic side. Conclusion. The new procedure provided information on the amplitude and symmetry of lateral pelvic displacement in unimpaired adults and was sensitive to deviations of a person with a walking abnormality.

An Aid for the Management of Shoulder Pain in Hemiplegia

This article describes the manufacture and use of a splint jacket which has proved to be of great value in the relief of severe shoulder pain in a hemiplegic person. It may be of use to others with this problem.

Foot positions in standing posture on normals and hemiplegic persons

Foot positions in standing posture on normals and hemiplegic persons

Right-Left Discrimination Skills of Hemiplegic Persons of Limited Intelligence

Past research has indicated a relationship between degree of unilateral usage of body parts and right-left discrimination skills. Further evidence for such an association was sought by comparing the scores of hemiplegic persons of limited intelligence on a test of rather advanced righ-left discrimination skills devised by the authors to those earned by a control group of non-hemiplegic persons matched on the variables of age, sex, race, and IQ. Mean scores of the hemiplegic group were significantly higher than those of the control group. Seventeen out of 21 hemiplegic persons scored higher than their matched controls. Results are discussed in terms of a possible causal relationship between perceived visual and kinesthetic differences between the right and left sides of one's own body and right-left discrimination in external space. Lesser degrees of inter-hemispheric communication among hemiplegic persons also are mentioned as a possible causal factor.