Lower Extremity Motor Dysfunction Research Articles

The correlation of gait and muscle activation characteristics with locomotion dysfunction grade in elderly individuals.

To investigate the differences and regularity of gait and muscle activation characteristics parameters in the Locomotion Dysfunction Grade (LDG) scale assessment in elderly individuals, and analyse the correlation between objective parameters and scale grading. Thus, to propose a novel detection mode for elderly individuals, which combined the LDG scale with objective detection. It can not only provide quantitative data for intelligent evaluation and rehabilitation, but also provided more accurate reference for the classification of care levels in elderly care policies. Elderly individuals (n = 159) who underwent gait analysis and sEMG at the Chinese Rehabilitation Research Center from January 2019 to September 2023 were included. According to the LDG scale, the elderly individuals were divided into four groups, namely, the LDG4, LDG5, LDG6 groups and the healthy control group. Four indicators, namely, spatiotemporal, kinematic, dynamic gait parameters and muscle activation characteristics data, were collected. Changes in these characteristics of elderly individuals with lower extremity motor dysfunction were evaluated and analysed statistically. The spatiotemporal gait parameters were significantly lower in the LDG4, LDG5, LDG6 groups than in the healthy control group. The double support phase was positively correlated with the LDG, while the swing phase, step length and velocity were negatively correlated (P < 0.05). The movement angles of both hips, knees and ankles were significantly limited and negatively correlated with the LDG (P < 0.05). Compared with those in the healthy control group, the centre of pressure (COP) path length were greater, and the average COP velocity was significantly lower (P < 0.05) in the LDG4, LDG5, LDG6 groups. The regularity of muscle activation clearly changed. The root mean square of the gastrocnemius medialis was positively correlated with LDG (P < 0.05), while the tibialis anterior showed no regularity. As the LDG increased, the differences in spatiotemporal, kinematic and dynamic gait parameters between elderly individuals with motor dysfunction and the healthy individuals gradually increased. The muscle activation characteristics parameters showed an abnormal activation pattern. These parameters were correlated with the LDG, providing a more comprehensive and objective assessment of lower extremity motor function in elderly individuals, improve assessment accuracy, and help accurate rehabilitation.

Disparities in Indications and Outcomes Reporting for Spinal Column Shortening for Tethered Cord Syndrome: The Need for a Standardized Approach.

Systematic review. To identify commonly reported indications and outcomes in spinal column shortening (SCS) procedures. SCS is a surgical procedure used in patients with tethered cord syndrome (TCS)-characterized by abnormal attachment of neural components to surrounding tissues-to shorten the vertebral column, release tension on the spinal cord/neural elements, and alleviate associated symptoms. PubMed and EMBASE searches captured SCS literature published between 1950 and 2023. Prospective/retrospective cohort studies and case series were included without age limit or required follow-up period. Review articles without new patient presentations, meta-analyses, systematic reviews, conference abstracts, and letters were excluded. Studies included adult and pediatric patients. The 29 identified studies represented 278 patients (age 5-76y). In 24.1% of studies, patients underwent primary TCS intervention via SCS. In 41.4% of studies, patients underwent SCS after failed previous primary detethering (24.1% of studies were mixed and 10.3% were unspecified). The most commonly reported non-genitourinary/bowel surgical indications were back pain (55.2%), lower-extremity pain (48.3%), lower-extremity weakness (48.3%), lower-extremity numbness (34.5%), and lower-extremity motor dysfunction (34.5%). Genitourinary/bowel symptoms were most often described as nonspecific bladder dysfunction (58.6%), bladder incontinence (34.5%), and bowel dysfunction (31.0%). After SCS, non-genitourinary/bowel outcomes included lower-extremity pain (44.8%), back pain (31.0%), and lower-extremity sensory and motor function (both 31.0%). Bladder dysfunction (79.3%), bowel dysfunction (34.5%), and bladder incontinence (13.8%) were commonly reported genitourinary/bowel outcomes. In total, 40 presenting surgical indication categories and 33 unique outcome measures were reported across studies. Seventeen of the 278 patients (6.1%) experienced a complication. The SCS surgical literature displays variability in operative indications and postoperative outcomes. The lack of common reporting mechanisms impedes higher-level analysis. A standardized outcomes measurement tool, encompassing both patient-reported outcome measures and objective metrics, is necessary. Level 4.

Feasibility of Seated Stepping and Handshaking as a Cardiopulmonary Exercise Testing: A Pilot Study

Cardiopulmonary function is usually assessed by cardiopulmonary exercise testing (CPX) using a cycle ergometer (CE-CPX) or a treadmill, which is difficult in patients with lower extremity motor dysfunction. A stepping and handshaking (SHS) exercise has been developed that can be performed safely and easily while sitting on a chair. This study compared peak oxygen uptake (peak V.O2) between CE-CPX and SHS-CPX in healthy adults and investigated the safety and validity of SHS-CPX. Twenty young adults (mean age 27.8 ± 4.4 years) were randomly assigned to perform CE-CPX or SHS-CPX, with the other test to follow 1-2 weeks later. The peak V.O2, respiratory exchange ratio (RER), peak heart rate, blood pressure, and test completion time were compared between CE-CPX and SHS-CPX. All subjects completed the examination and met the criteria for peak V.O2. SHS-CPX and CE-CPX showed a strong correlation with peak V.O2 (r = 0.85, p < 0.0001). The peak V.O2 (40.4 ± 11.3 mL/min/kg vs. 28.9 ± 8.0 mL/min/kg), peak heart rate (190.6 ± 8.9 bpm vs. 172.1 ± 12.6 bpm), and test completion time (1052.8 ± 143.7 s vs. 609.1 ± 96.2 s) were significantly lower in the SHS-CPX (p < 0.0001). There were no adverse events. The peak V.O2 with SHS-CPX was equivalent to about 70% of that with CE-CPX despite the exercise being performed in a sitting position, suggesting its suitability as a submaximal exercise test.

Computer Vision and Machine Learning-Based Gait Pattern Recognition for Flat Fall Prediction.

Background: Gait recognition has been applied in the prediction of the probability of elderly flat ground fall, functional evaluation during rehabilitation, and the training of patients with lower extremity motor dysfunction. Gait distinguishing between seemingly similar kinematic patterns associated with different pathological entities is a challenge for the clinician. How to realize automatic identification and judgment of abnormal gait is a significant challenge in clinical practice. The long-term goal of our study is to develop a gait recognition computer vision system using artificial intelligence (AI) and machine learning (ML) computing. This study aims to find an optimal ML algorithm using computer vision techniques and measure variables from lower limbs to classify gait patterns in healthy people. The purpose of this study is to determine the feasibility of computer vision and machine learning (ML) computing in discriminating different gait patterns associated with flat-ground falls. Methods: We used the Kinect® Motion system to capture the spatiotemporal gait data from seven healthy subjects in three walking trials, including normal gait, pelvic-obliquity-gait, and knee-hyperextension-gait walking. Four different classification methods including convolutional neural network (CNN), support vector machine (SVM), K-nearest neighbors (KNN), and long short-term memory (LSTM) neural networks were used to automatically classify three gait patterns. Overall, 750 sets of data were collected, and the dataset was divided into 80% for algorithm training and 20% for evaluation. Results: The SVM and KNN had a higher accuracy than CNN and LSTM. The SVM (94.9 ± 3.36%) had the highest accuracy in the classification of gait patterns, followed by KNN (94.0 ± 4.22%). The accuracy of CNN was 87.6 ± 7.50% and that of LSTM 83.6 ± 5.35%. Conclusions: This study revealed that the proposed AI machine learning (ML) techniques can be used to design gait biometric systems and machine vision for gait pattern recognition. Potentially, this method can be used to remotely evaluate elderly patients and help clinicians make decisions regarding disposition, follow-up, and treatment.

Application Progress of Transcranial Direct Current Stimulation Combined with Limb Therapy in Rehabilitation of Lower Limbs after Stroke

Motor dysfunction of lower extremities is one of the most common and urgent problems to be solved in patients with stroke. Even if early and standardized rehabilitation therapy, there are still many patients who cannot restore their walking function or have serious abnormal gait after 6 months of onset. It has a great impact on their daily activities and self-care ability, and brings a heavy economic burden to the society and family financial situation. Rehabilitation interventions for motor dysfunction of lower extremities include central intervention techniques and peripheral intervention techniques. Central intervention technology stimulates the brain, such as neuroregulation and scalp acupuncture, while peripheral intervention technology stimulates limbs, such as functional electrical stimulation (FES) and robot-assisted gait training (RAGT). Although the two technologies have different stimulation targets, the same purpose, previous studies found that the treatment effect was better when combined application of effective central intervention technology with peripheral intervention technology. It is called brain-limb coordinated regulation therapy technology, which can be divided into brain-upper-limb coordinated therapy mode and brain-lower-limb coordinated therapy mode according to different coordinated parts. The technology can be divided into synchronous brain-limb coordination therapy mode and asynchronous brain-limb coordination therapy mode according to the different coordination sequence. The asynchronous mode can be further divided into the mode of stimulating the brain first and then the limbs, and the mode of stimulating the limbs first and then the brain. At present, this technique is widely used in clinical research. Transcranial direct current stimulation (tDCS) is widely used in combination with lower limb rehabilitation therapy because of its advantages such as high safety, easy to carry equipment and long delayed effect time. However, the therapeutic effect of this kind of synergistic therapy is quite different, due to the different lower limb rehabilitation techniques and different sequence involved in the synergistic therapy. This article reviews the application progress of tDCS with different treatment parameters combined with different lower limb rehabilitation techniques and different cooperative treatment sequence in stroke, and discusses the factors which affect the effect of cooperative treatment and the possible effective cooperative treatment mode, in order to provide new ideas for the treatment of lower limb dysfunction after stroke.

A Multi-Information Fusion Method for Gait Phase Classification in Lower Limb Rehabilitation Exoskeleton.

Gait phase classification is important for rehabilitation training in patients with lower extremity motor dysfunction. Classification accuracy of the gait phase also directly affects the effect and rehabilitation training cycle. In this article, a multiple information (multi-information) fusion method for gait phase classification in lower limb rehabilitation exoskeleton is proposed to improve the classification accuracy. The advantage of this method is that a multi-information acquisition system is constructed, and a variety of information directly related to gait movement is synchronously collected. Multi-information includes the surface electromyography (sEMG) signals of the human lower limb during the gait movement, the angle information of the knee joints, and the plantar pressure information. The acquired multi-information is processed and input into a modified convolutional neural network (CNN) model to classify the gait phase. The experiment of gait phase classification with multi-information is carried out under different speed conditions, and the experiment is analyzed to obtain higher accuracy. At the same time, the gait phase classification results of multi-information and single information are compared. The experimental results verify the effectiveness of the multi-information fusion method. In addition, the delay time of each sensor and model classification time is measured, which shows that the system has tremendous real-time performance.

Effectiveness of Motor Imagery Training for Lower Extremity Motor Function in Patients With Stroke: A Systematic Review and Meta-Analysis

<h3>Objective(s)</h3> Motor imagery training (MIT) is considered an emerging and non-invasive rehabilitation technique that patients could easily master to improve functional outcomes. To evaluate the effectiveness of MIT combined with conventional rehabilitation therapy (CRT) in treatment of lower extremity motor functions (LEMFs) in patients with stroke. <h3>Data Sources</h3> PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials, Chinese Biomedical Literatures database, Chinese National Knowledge Infrastructure, Wan-Fang Database, and Chinese Scientific Journals Database were researched from the earliest records to December 1, 2020. <h3>Study Selection</h3> Randomized controlled trials (RCTs) that compared MIT associated with CRT versus a control CRT in patients with lower extremity motor dysfunction after stroke, were selected. Among the 781 records screened, 15 trials, in which motor imagination questionnaires clearly performed, were included with 761 eligible patients. <h3>Data Extraction</h3> Pooled outcome data were completed by two researchers independently. Primary evaluation index was the Fugl-Meyer assessment scale-Lower extremity (FMA-LE). The second evaluation indices were Functional Ambulation Category (FAC) and Berg Balance Scale (BBS). Meanwhile, the methodological quality of included studies was conducted via the Physiotherapy Evidence Database scale and the Cochrane risk of bias criteria tools. <h3>Data Synthesis</h3> Meta-analysis showed that there existed statistically significant improvements in FMA-LE (WMD=3.65, 95%CI=2.52, 4.78, P < 0.00001), FAC (WMD=0.80, 95% CI=0.22, 1.38, P=0.006) and BBS (WMD=6.15, 95% CI=2.98, 9.32, P=0.0001) in the MIT associated with CRT group versus the control group after an intervention of more than 3 weeks. <h3>Conclusions</h3> MIT associated with CRT had better effectiveness in LEMFs than CRT alone. <h3>Author(s) Disclosures</h3> None.

Clinical presentation and treatment outcomes of spinal epidural arteriovenous fistulas.

OBJECTIVE Spinal epidural arteriovenous fistulas (SEDAVFs) constitute a rare but treatable cause of vascular myelopathy and are a different subtype from the more common Type I spinal dural AVFs. The purpose of this study was to review a consecutive series of SEDAVFs from a single institution and report on the clinical presentations, functional status, and treatment outcomes. METHODS The authors identified all SEDAVFs treated at their institution from 2005 to 2015. SEDAVFs were defined as spinal AVFs in which the fistulous connection occurred in the epidural venous plexus. The clinical presentation, functional status, immediate treatment outcomes, and long-term neurological outcomes were analyzed. RESULTS Twenty-four patients with SEDAVFs were included in this study. The patients' mean age at presentation was 66.9 years. The most common presenting symptoms were pain and numbness (22 patients, 91.7%), followed by lower-extremity weakness (21 patients, 87.5%). The mean duration of symptoms prior to diagnosis was 11.8 months. Eighteen patients (75.0%) were treated with endovascular therapy alone, 4 (16.7) with surgery, and 2 (8.3%) with a combination of techniques. There was 1 major treatment-related complication (4.2%). Fifteen patients (62.5%) had improvement in disability, and 12 patients (54.5%) had improvement in sensory symptoms. CONCLUSIONS SEDAVFs often present with lower-extremity motor dysfunction and sensory symptoms. With the availability of newer liquid embolic agents, these lesions can be effectively treated with endovascular techniques. Surgery is also effective at treating these lesions, especially in situations where endovascular embolization fails or is not safe and in patients presenting with mass effect from compressive varices.

Homogeneous spinal-shortening axial decompression procedure for tethered cord syndrome

Surgical detethering is a traditional treatment for symptomatic tethered cord syndrome. However, such complications as cerebrospinal fluid leakage and neurologic deterioration are common. Homogeneous spinal-shortening axial decompression (HSAD) is a modified procedure of monosegmental spinal-shortening osteotomy and it is a novel surgical alternative of reducing neural tension indirectly. The objective was to evaluate the surgical outcomes of HSAD for tethered cord syndrome. The surgical outcomes were examined for 15 consecutive patients with tethered cord syndrome undergoing HSAD from April 2010 to July 2014. Improvements of neurological symptoms including urinary dysfunction, lower-extremity motor and sensory disturbances and/or gait abnormalities, low-back and/or lower-extremity pain, bowel incontinence and sexual dysfunction were evaluated. Their average follow-up period was 21.5 months. The length of spinal column shortening was 17.2 ± 2.9 mm. Urinary dysfunction (n = 9) was the most common residual deficit. All 9 patients with urological symptoms reported improvements, although deficits persisted at the last follow-up. All patients with lower-extremity motor dysfunction improved and 4 (50.0%) noted complete resolution of preoperative lower-extremity sensory symptoms. All patients reported immediate low-back or lower-extremity pain relief after HSAD. One patient reported improved sexual functioning and regained complete erectile capabilities. Two patients (11%) experienced less satisfactory symptomatic or functional benefit from HSAD. However, the main objective of surgery was to prevent further worsening of neurological status. Complete bone union at osteotomy site was noted in all cases at the last follow-up. As a novel surgical option for tethered cord syndrome, HSAD may avoid such complications as cerebrospinal fluid leakage or neurologic deterioration commonly encountered during traditional detethering surgery. All patients gain satisfactory functional outcomes without complications compared to their preoperative symptoms.

Multisegmental Spinal-Shortening Osteotomy for the Treatment of Tethered Cord Syndrome: A Retrospective Study of Six Consecutive Cases

Introduction Tethered cord syndrome often presents as low back pain in the early stage and progresses to sensory, motor, bowel, and bladder control dysfunctions. The pathogenesis of tethered cord syndrome is thought to be abnormal longitudinal traction on the caudal end of the spinal cord. Surgical detethering has been considered the gold standard for symptomatic tethered cord syndrome and consistently shown to be effective. However, complications such as cerebrospinal fluid leakage, infection, and neurologic deterioration including motor and bladder function are common. To minimize these complications, vertebral column subtraction osteotomy and pedicle subtraction osteotomy were reported as alternative procedures for the treatment of adult tethered cord syndrome. The concept of the procedures is to reduce neural tension indirectly. We present six consecutive cases with tethered cord syndrome that underwent a modified spinal-shortening osteotomy, which is multisegmental. Materials and Methods We retrospectively reviewed the surgical and radiological data of patients with tethered cord syndrome who underwent multisegmental spinal-shortening osteotomy (MSSO) by one doctor in one of the surgery groups at Changzheng Hospital from July 2009 to July 2013. The average follow-up period was 32 ± 7.5 months. Three patients were male and three were female and the average age at operation was 33 years (range, 16-57 years). MSSO were performed in patients, which required multilevel discectomy and facetectomy. The certain length gap created by the discectomy and facetectomy were then closed with serial compression through the domino connectors. Temporary rods were replaced with permanent rods once final spinal column alignment was achieved. The shortening of the spine was measured at the anterior and posterior borders and the midpoint of the vertebral end plate on the lateral fluoroscopy. Preoperative and postoperative VAS pain scores were evaluated. Results Six patients were followed up for 32 months in average and were included in the analysis. The length of spinal column shortening was 17 ± 1.7 mm. Urinary and sensory dysfunctions (two cases for each) were the most common residual deficits. Two (100%) patients with urological symptoms reported improvements, although deficits remained at the time of last follow-up. Six patients with lower-extremity motor dysfunction improved and six noted complete resolution of preoperative lower-extremity sensory symptoms. Five (100%) reported immediate low back or lower extremity pain relief following MSSO. VAS pain scores of all six patients were greatly improved after surgery. Complete bone union at the osteotomy site was noted in all cases at the time of last follow-up. Conclusion Most of the patients who have undergone MSSO in our study exhibited improvement of urological symptoms, complete recovery of motor functioning, and relief of debilitating back or lower extremity pain. Although many factors preclude a direct comparison of the symptomatic and functional outcomes following traditional surgical detethering compared with MSSO for TCS treatment, the outcomes are grossly similar regarding current literature. We believe that the principal benefits of MSSO over detethering operations will be in preserving the symptomatic and functional neurological improvements with lasting results and potentially obviating the need for future reoperations. However, longer follow-up results are needed from the MSSO series to support this belief. Disclosure of Interest None declared References Agarwalla PK, Dunn IF, Scott RM, Smith ER. Tethered cord syndrome. Neurosurg Clin N Am 2007;18(3):531–547 Alemdaroğlu KB, Atlihan D, Cimen O, Kilinç CY, Iltar S. Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves. Eur Spine J 2007;16(9):1451–1457 Hsieh PC, Stapleton CJ, Moldavskiy P, et al. Posterior vertebral column subtraction osteotomy for the treatment of tethered cord syndrome: review of the literature and clinical outcomes of all cases reported to date. Neurosurg Focus 2010;29(1):E6 Kanno H, Aizawa T, Ozawa H, Hoshikawa T, Itoi E, Kokubun S. Spine-shortening vertebral osteotomy in a patient with tethered cord syndrome and a vertebral fracture. Case report. J Neurosurg Spine 2008;9(1):62–66 Kawahara N, Tomita K, Kobayashi T, Abdel-Wanis ME, Murakami H, Akamaru T. Influence of acute shortening on the spinal cord: an experimental study. Spine 2005;30(6):613–620 Kokubun S, Ozawa H, Aizawa T, Ly NM, Tanaka Y. Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine 2011;15(1):21–27 Miyakoshi N, Abe E, Suzuki T, Kido T, Chiba M, Shimada Y. Spine-shortening vertebral osteotomy for tethered cord syndrome: report of three cases. Spine 2009;34(22):E823-E825 Traynelis VC. Spine shortening of tethered cord. J Neurosurg Spine 2011;15(1):19-20, author reply 20

Pentosan polysulfate treatment ameliorates motor function with increased serum soluble vascular cell adhesion molecule-1 in HTLV-1-associated neurologic disease

The main therapeutic strategy against human T lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) characterized by lower extremity motor dysfunction is immunomodulatory treatment, with drugs such as corticosteroid hormone and interferon-α, at present. However, there are many issues in long-term treatment with these drugs, such as insufficient effects and various side effects. We now urgently need to develop other therapeutic strategies. The heparinoid, pentosan polysulfate sodium (PPS), has been safely used in Europe for the past 50 years as a thrombosis prophylaxis and for the treatment of phlebitis. We conducted a clinical trial to test the effect of subcutaneous administration of PPS in 12 patients with HAM/TSP in an open-labeled design. There was a marked improvement in lower extremity motor function, based on reduced spasticity, such as a reduced time required for walking 10 m and descending a flight of stairs. There were no significant changes in HTLV-I proviral copy numbers in peripheral blood contrary to the inhibitory effect of PPS in vitro for intercellular spread of HTLV-I. However, serum soluble vascular cell adhesion molecule (sVCAM)-1 was significantly increased without significant changes of serum level of chemokines (CXCL10 and CCL2). There was a positive correlation between increased sVCAM-1and reduced time required for walking 10 m. PPS might induce neurological improvement by inhibition of chronic inflammation in the spinal cord, through blocking the adhesion cascade by increasing serum sVCAM-1, in addition to rheological improvement of the microcirculation. PPS has the potential to be a new therapeutic tool for HAM/TSP.

Lower Extremity Motor Function and Disability in Mild Cognitive Impairment

Recent findings suggest that lower extremity motor dysfunction may be a feature of mild cognitive impairment (MCI), but little is known about the nature and significance of lower extremity motor dysfunction in MCI. The aim of this study was to examine the extent to which MCI is associated with impaired gait, balance, and strength and to examine the relation of lower extremity function to disability among persons with MCI in the Rush Memory and Aging Project, a clinical-pathologic study of common chronic conditions of old age. In a series of analyses adjusted for age, sex, and education, individuals with MCI exhibited more impaired gait and balance than individuals without cognitive impairment. Because vascular factors can contribute to lower extremity motor dysfunction, the authors repeated the initial analyses including terms for vascular risk factors and vascular disease, and the associations between MCI and lower extremity motor dysfunction persisted. Moreover, among those with MCI, impairments in gait and balance were associated with an increased likelihood of disability. These findings suggest that lower extremity motor dysfunction is common and contributes to disability in MCI, but lower extremity motor dysfunction in MCI does not appear to be explained by the vascular factors examined in this study.

Timed Gait Test: Normative Data for the Assessment of the AIDS Dementia Complex

The Timed Gait test is a standardized procedure assessing motor dysfunction of lower extremities and gait abnormalities associated with AIDS dementia complex. Heretofore, interpretations of Timed Gait results have been hampered by the lack of normative data. We provide results on this test derived from 1,549 subjects (HIV−seronegatives (HIV−) and seropositives (HIV+) classified according to ADC stage). Timed Gait was found to be a useful screening and assessment tool for evaluating ADC and correlated with clinical ADC staging as well as more extensive structured neurological and neuropsychological evaluations. Analysis of covariance results (with age and education as covariates) revealed symptomatic HIV+(SX) and AIDS groups having significantly slower Timed Gait scores than those in the HIV− and asymptomatic HIV+(ASX) groups. The SX group obtained significantly slower timed gait scores than those in the AIDS group. There was a significant increase in Timed Gait scores with each increase in dementia staging with the HIV− subjects having the fastest mean Timed Gait scores and the HIV+ dementia stage 2+ having the slowest. These normative data should prove useful in both recognition of ADC and treatment response. Given its minimal training requirements, the Timed Gait would have utility in resource limited settings.

Inter-rater reliability and construct validity of the LaVigne Motor Recovery Assessment Scale following a cerebrovascular accident

Several authors in the field of physical rehabilitation have used the concept of motor recovery to measure the post-cerebrovascular accident motor function of the affected limbs of adult hemiplegic subjects. The LaVigne test is composed of 95 items to assess motor recovery. This test uses the seven motor recovery stages identified by Brunnstrom. The first objective of the present study was to establish inter-rater reliability for the scores of upper extremity, lower extremity and hand motor function using a scoring system devised by LaVigne. The second objective was to explore the construct validity of the LaVigne test. Thirty-six CVA subjects were assessed by two independent physiotherapists. Inter-rater reliability was found to be high for the total scores of upper extremity (R = 0.70–0.92) and hand (R = 0.88–0.96) motor recovery. Inter-rater reliability coefficients were not as high for the total scores of lower extremity motor dysfunction (R = 0.50–0.88). The seven mutually exclusive graded stages des...

Workspace for disabled people

The paper aims at determining the workspace for disabled young people. The investigation embraced a group of young people with motor dysfunction of lower extremities. Seventeen measurements were taken of 32 boys and 45 girls aged 15-18. There are significant differences in functional dimensions of the arm between the healthy and the disabled populations. The differences clearly indicate that there is a need for different shaping of space in which people of limited motor efficiency must function. A method based on Das and Grady's concept was used in determining workspace. This method was modified by the author. The method allows determination of workspace by means of several simple anthropometric measurements. Workspace for young people investigated was determined for the sitting position in transverse and sagittal planes. The results of the investigation constitute data for design and estimation of workplaces for disabled young people with motor dysfunction of lower extremities. The results can also be used to determine functional space in classrooms, school workshops, educational and rehabilitation centres.