Lower Extremity Motor Function Research Articles

141 Motor and Somatosensory Applications for Nerve Cuff Electrodes in Clinical Neuroprosthesis and Neurorehabilitation

INTRODUCTION: Surgically implanted neuroprosthetics aim to restore motor and somatosensory function by delivering controlled electrical impulses to paralyzed nerves. Recently, nerve cuff electrodes (NCEs) have been increasingly studied and may eventually offer the potential to recover somatomotor function in patients with neurologic injury. METHODS: The PubMed, Google Scholar, and Web of Science databases were searched to identify relevant articles published between 2012 – 2022 describing use of neuroprosthetic NCEs for clinical somatomotor rehabilitation. Data from all relevant articles retrieved were collected and summarized. RESULTS: NCE-neural interfaces can restore both upper and lower extremity motor function in spinal cord injury patients and may provide a treatment modality superior to that of muscle-based electrodes. The search yielded 137 studies, and of those reviewed, 18 were original research articles that used peripheral nerve stimulation to elicit motor actions and/or somatosensory perceptions through NCEs. 10 studies looked at restoring motor function in patients with spinal cord injuries or stroke-related paralysis and 7 studies looked at somatosensory applications of NCEs in patients with amputations. Currently, sensory NCE interfacing can restore and improve multiple aspects of sensation in amputees. While there is room for further study in various applications, technological improvements and wider clinical adoption, NCEs have been demonstrated to provide a clinically acceptable option in reducing intraoperative duration and morbidity, while preserving long-term functional stability, threshold charge maintenance, and acceptable mechanical failure rates. CONCLUSIONS: NCEs appear to be a promising avenue for future research in the field of neuroprosthetics. As the translational avenue continues to mature and more clinical studies become avaiable, the utility of NCEs will be better understood.

Translation, reliability, and validation of the Lower Extremity Motor Function Test (LEMFT) in stroke survivors

Translation, reliability, and validation of the Lower Extremity Motor Function Test (LEMFT) in stroke survivors

Effects of early mobilization within 48 hours of injury in patients with incomplete cervical spinal cord injury

Objective To investigate the effects of early mobilization within 48 h of injury on motor function and walking ability in patients with incomplete cervical spinal cord injury (SCI). Design A retrospective observational study. Setting Intensive care unit or high care unit of a university hospital emergency center. Participants Of 224 patients with SCI having American Spinal Injury Association impairment scale grades C and D, 158 consecutive patients hospitalized for at least 3 weeks after injury were included. Interventions Patients were categorized into two groups: an early mobilization group in which patients were mobilized within 48 h of injury and a delayed mobilization group in which they were mobilized after 48 h of injury. Outcome measures The upper extremity motor score (UEMS), lower extremity motor score (LEMS), and Walking Index for Spinal Cord Injury II (WISCI II) were compared using propensity score matching analysis. Results Of the 158 patients who met the eligibility criteria, 32 were matched between the groups. There was a significant difference in the change in LEMS from the initial assessment to the assessment 2 weeks postoperatively in the early mobilization group (median 9 points vs. 3 points, p < 0.05). There were no significant differences in UEMS or WISCI II. Conclusion Early mobilization within 48 h may improve lower extremity motor function in patients with acute incomplete cervical SCI.

Effects of adding neuromuscular electrical stimulation to functional training on muscle recruitment, pain reduction, and knee joint function in patellofemoral pain syndrome patients.

Impaired lower extremity motor function and knee pain are common concerns in patients with patellofemoral pain syndrome (PFPS). It is essential to plan therapeutic techniques to therapy PFPS. The objective of this study was to determine the effect of neuromuscular electrical stimulation (NMES) combined with functional training on pain, lower extremity function and muscle recruitment in patients with PFPS. Twenty-four PFPS patients (male-13, female-11) were selected to conduct this study finally. Two groups were formed: the control group (n = 12) which included functional training only and the experimental group (n = 12) which functional training along with NMES-in both groups interventions were performed for 45 minutes/session, 3 days/weeks for 6 weeks. The functional training consisted of warm-up activities, strength training, balance training, and relaxation activities. All patients were evaluated with surface electromyography testing system for the root mean square and integrated electromyography of vastus medial oblique (VMO), vastus lateralis (VL), and VMO/VL ratio, visual analog scores (VAS) for pain, and Kujala functional score for knee joint function before and after 6 weeks. Normality was tested for all outcome variables using Shapiro-Wilk test. Nonparametric (Mann-Whitney U test and Wilcoxon signed-rank test) tests were used to analyze data. A 2-way analysis of variance with repeated measures (group*time) was applied to analyze the data. A significant increases (P < .001) root mean square and integrated electromyography of VMO, VMO/VL ratio, and Kujala score in both groups, For VAS scores, significant decreases was observed in both groups. When both groups were compared, greater improvement (P < .05) was observed in the experimental group in comparison the control group for both knee pain, lower extremity function and muscle recruitment. However, there was no difference in VL muscle recruitment between the 2 groups. Functional training and NMES combined with functional training are helpful to improve pain, knee function and muscle recruitment of PFPS patients. NMES combined with functional training was more effective compared to the control group. This may help clinical trialists to use different NMES to synchronize other interventions in future studies to enhance rehabilitation efficacy in PFPS patients through passive training versus active stimulation.

Prenatal surgery in fetal myelomeningocele with severe ventriculomegaly.

Prenatal myelomeningocele (MMC) repair is performed to decrease risk for treatment of hydrocephalus after birth and to preserve motor function. Some centers may not consider patients candidates for surgery if severe ventriculomegaly is present and there is no expected benefit in decreased risk for hydrocephalus treatment. This study sought to compare postnatal outcomes of fetuses with MMC and severe ventriculomegaly (>15mm) who underwent prenatal repair, with fetuses with severe ventriculomegaly who underwent postnatal repair and fetuses with ventriculomegaly (<15mm) who underwent prenatal repair. This was a retrospective study of fetuses with MMC that underwent prenatal or postnatal repair between 2012 and 2021 at a single institution. The cohort was divided based on preoperative fetal ventricular size into two groups, those with severe ventriculomegaly (≥15 mm) and those without severe ventriculomegaly (<15 mm). Fetal ventricular size was measured by MRI prior to surgery using the standardized approach and the mean of the left and right ventricle was used for analysis. Motor function of lower extremities was assessed at the time of referral by ultrasound and if flexion-extension movements of the ankle were seen, it was considered as preserved S1 motor function. Postnatal outcomes including motor function of lower extremities assessed at birth and need for diversion procedure for hydrocephalus treatment during the first year of life were collected and compared between groups. Data was presented as median and range or number and percentages as appropriate. P value >0.05 was considered statistically significant. Multivariate regression analysis was used to adjust for potential confounders. 154 patients were included in this study: 145 patients underwent fetal surgery (101 fetoscopic and 44 open hysterotomy) and 9 patients with severe ventriculomegaly underwent postnatal repair. Among the 145 patients who underwent fetal surgery, 22 presented with severe ventriculomegaly. Prenatally repaired fetuses with severe ventriculomegaly at referral were at a significantly higher need for hydrocephalus treatment by 12 months than those without severe ventriculomegaly (62% vs. 29%, p<0.01). However, motor function assessment at birth was similar between both prenatally repaired groups (OR=0.92, 95% CI [0.33-2.59], p=0.88) adjusted for the anatomical level of the lesion. The prenatally repaired group with severe ventriculomegaly had better preserved motor function levels at birth compared to the postnatal repair group with severe ventriculomegaly (L3 with 11.1% S1 motor function; p=<0.01 and p=<0.01). Prenatally repaired patients with severe ventriculomegaly had an 18.9 times chance of having an intact motor function at birth [95% CI (1.2 - 290.1)] adjusted for ethnicity, presence of clubfeet at referral, and gestational age at delivery compared to postnatal repair. There was not a significant difference in the need for hydrocephalus treatment in the first year of life between prenatal and postnatal repair of patients with severe ventriculomegaly (61.9% vs 87.5%, p=0.18). Although fetuses with MMC and severe ventriculomegaly do not seem to benefit from fetal surgery in terms of postnatal hydrocephalus treatment, they benefit from increased chance of preserved motor function at birth. Results from this study highlight the benefits of having prenatal MMC repair for cases with severe ventriculomegaly at referral to preserve motor function. This article is protected by copyright. All rights reserved.

Effectiveness of Rehabilitative Interventions Beginning within the First Month of Stroke Onset in Improving Lower Extremity-related Outcomes: A Systematic Review and Network Meta-Analysis

Reviews about early interventions, which are important in stroke rehabilitation due to significant neural plasticity, are relatively less. This study objective was to investigate the effectiveness of different interventions started within one-month post-stroke in improving lower extremity-related outcomes as compared to conventional rehabilitation and the corresponding effectiveness ranking. Cochrane Library, Ovid, PubMed, and Scopus were searched for articles dated up to 18 March 2022. Randomised controlled trials were included if they evaluated the effectiveness of two or more different non-drug, non-invasive, and non-surgical interventions which were started within one-month post-stroke on lower extremity-related outcomes. Network meta-analysis revealed that transcranial direct current stimulation, repetitive transcranial magnetic stimulation, mirror therapy, cycling, transcutaneous auricular vagus nerve stimulation, neuromuscular electrical stimulation (NMES), combination of robot and NMES, and thermal stimulation were significantly more effective in improving lower extremity motor function than conventional rehabilitation. In improving mobility, mirror therapy, cycling, and thermal stimulation were significantly more effective. In enhancing balance, physio ball, transcutaneous electrical nerve stimulation, cycling, thermal stimulation, and robot showed significantly higher effectiveness. Thermal stimulation scored the highest effectiveness ranking in improving lower extremity motor function and mobility whereas robot and backward walking achieved the highest effectiveness ranking in improving balance and gait speed respectively.

Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis

The combination of mirror therapy (MT) and neuromuscular electrical stimulation (NMES) has been devised as an intervention method in stroke rehabilitation; however, few studies have investigated its efficacy in lower extremity motor function recovery. In this systematic review and meta-analysis, we examined the effectiveness of combined MT and NMES therapy in improving poststroke walking speed, spasticity, balance and other gait parameters. Randomized controlled trials (RCTs) were selected from PubMed, Cochrane Library, EMBASE, and Scopus databases. In total, six RCTs which involving 181 participants were included. Our findings indicate that MT combined with NMES elicits greater improvement relative to control group in walking speed (SMD = 0.67, 95% confidence interval [CI] 0.26–1.07, P = 0.001), Berg Balance Scale (SMD = 0.72; 95% CI 0.31–1.13; P = 0.0007), cadence (SMD = 0.59, 95% CI 0.02–1.16, P = 0.04), step length (SMD = 0.94, 95% CI 0.35–1.53, P = 0.002), and stride length (SMD = 0.95, 95% CI 0.36–1.54, P = 0.002) but not in modified Ashworth scale (SMD = − 0.40, 95% CI − 1.05 to 0.26, P = 0.23). Our findings suggest that MT combined with NMES may be a suitable supplemental intervention to conventional therapy in stroke survivors.

Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable.

Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.

Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable.

Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.

Mapping of the supplementary motor area using repetitive navigated transcranial magnetic stimulation.

The supplementary motor area (SMA) is important for motor and language function. Damage to the SMA may harm these functions, yet tools for a preoperative assessment of the area are still sparse. The aim of this study was to validate a mapping protocol using repetitive navigated transcranial magnetic stimulation (rnTMS) and extend this protocol for both hemispheres and lower extremities. To this purpose, the SMA of both hemispheres were mapped based on a finger tapping task for 30 healthy subjects (35.97 ± 15.11, range 21-67 years; 14 females) using rnTMS at 20 Hz (120% resting motor threshold (RMT)) while controlling for primary motor cortex activation. Points with induced errors were marked on the corresponding MRI. Next, on the identified SMA hotspot a bimanual finger tapping task and the Nine-Hole Peg Test (NHPT) were performed. Further, the lower extremity was mapped at 20 Hz (140%RMT) using a toe tapping task. Mean finger tapping scores decreased significantly during stimulation (25.70taps) compared to baseline (30.48; p < 0.01). Bimanual finger tapping led to a significant increase in taps during stimulation (28.43taps) compared to unimanual tapping (p < 0.01). Compared to baseline, completion time for the NHPT increased significantly during stimulation (baseline: 13.6 s, stimulation: 16.4 s; p < 0.01). No differences between hemispheres were observed. The current study validated and extended a rnTMS based protocol for the mapping of the SMA regarding motor function of upper and lower extremity. This protocol could be beneficial to better understand functional SMA organisation and improve preoperative planning in patients with SMA lesions.

Therapeutic Effectiveness of Brain Computer Interfaces in Stroke Patients: A Systematic Review.

Brain-computer interfaces (BCIs) are a rapidly advancing field which utilizes brain activity to control external devices for a myriad of functions, including the restoration of motor function. Clinically, BCIs have been especially impactful in patients who suffer from stroke-mediated damage. However, due to the rapid advancement in the field, there is a lack of accepted standards of practice. Therefore, the aim of this systematic review is to summarize the current literature published regarding the efficacy of BCI-based rehabilitation of motor dysfunction in stroke patients. This systematic review was performed in accordance with the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 statement. PubMed, Embase, and Cochrane Library were queried for relevant articles and screened for inclusion criteria by two authors. All discrepancies were resolved by discussion among both reviewers and subsequent consensus. 11/12 (91.6%) of studies focused on upper extremity outcomes and reported larger initial improvements for participants in the treatment arm (using BCI) as compared to those in the control arm (no BCI). 2/2 studies focused on lower extremity outcomes reported improvements for the treatment arm compared to the control arm. This systematic review illustrates the utility BCI has for the restoration of upper extremity and lower extremity motor function in stroke patients and supports further investigation of BCI for other clinical indications.

Treatment effects of low-frequency repetitive transcranial magnetic stimulation combined with motor relearning procedure on spasticity and limb motor function in stroke patients.

Limb paralysis, which is a sequela of stroke, limits patients' activities of daily living and lowers their quality of life. The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with a motor relearning procedure (MRP) on motor function and limb spasticity in stroke patients. Stroke patients were randomly divided into a combined treatment group (rTMS + MRP) and a control group (MRP) (n = 30 per group). The control group was given MRP in addition to conventional rehabilitation, and the combined treatment group was given 1 Hz rTMS combined with MRP. The treatment efficacy was assessed by the modified Ashworth scale (MAS), Fugl-Meyer motor function scale, and motor evoked potential (MEP) testing. After 4 weeks of treatment, the Brunnstrom score, Fugl-Meyer lower extremity motor function, and Fugl-Meyer balance function were significantly higher in the combination treatment group compared to the control group, while the MAS score was lower in the combination treatment group compared to the control group. The MEP extraction rate was higher in the combined treatment group compared to the control group, while the threshold and central motor conduction time (CMCT) were lower in the combined treatment group compared to the control group. Low-frequency rTMS combined with MRP had better efficacy on spasticity and motor function in stroke patients with hemiparesis than MRP alone.

Effectiveness of single leg standing up exercise for recovery of knee muscle strength and lower extremity motion function following anterior cruciate ligament reconstruction

PurposeWe investigated the effectiveness of single-leg standing exercise (SLSE) as a home-based self-exercise for the recovery of knee joint muscle strength and lower limb motor function after anterior cruciate ligament (ACL) reconstruction. MethodsIn addition to postoperative rehabilitation, 55 patients who underwent ACL repair were asked to begin SLSE as a home-based self-exercise 50 times per day using a platform elevated at 40 ​cm for 2 months, 30 ​cm at 3 months, 20 ​cm at 4 months, and 10 ​cm at 5 months (intervention group). Sixty-four patients who underwent ACL reconstruction and followed the existing rehabilitation protocol were included in the control group. Isokinetic knee extension and flexion at 60° angular velocity at 3, 8, and 10 months after surgery and lower limb motor function performance at 8 and 10 months after surgery were compared within and between the two groups. ResultsKnee extension and flexion muscle strength and lower-extremity motor function recovered over time in both groups. There were no significant differences in knee extension and flexion muscle strength between the two groups at 3 months after surgery. However, knee extension strength, flexion strength, and triple hop test (THT) results were significantly higher in the intervention group (p ​< ​0.01) 8 months after surgery. In addition, knee flexion strength and THT were significantly higher in the intervention group (p ​< ​0.01) 10 months after surgery. ConclusionsThe results of this study suggest that SLSE can be an effective exercise for recovering knee joint muscle strength and lower limb motor function.

Effect of Body Weight Support Training on Lower Extremity Motor Function in Patients With Spinal Cord Injury: A Systematic Review and Meta-analysis.

The aims of the study are to systematically evaluate the effect of body weight support training on lower extremity motor function(s) in patients with spinal cord injury and to compare the effect differences among three body weight support training methods. PubMed, Web of Science, Cochrane Library, Embase, CNKI, CBM, China Scientific Journal, and Wan Fang databases were searched until December 31, 2022. Meta-analysis and network meta-analysis were conducted using RevMan 5.4 and ADDIS 1.16.8. Nineteen randomized controlled trials involving 864 patients were included. The meta-analysis showed that body weight support training could improve lower extremity motor scores according to the International Standards for Neurological Classification of Spinal Cord Injury standard (mean difference = 6.38, 95% confidence interval = 3.96-8.80, P < 0.05), walking speed (standard mean difference = 0.77, 95% confidence interval = 0.52-1.02, P < 0.05), and modified Barthel Index scores (mean difference = 9.85, 95% confidence interval = 8.39-11.30, P < 0.05). The network meta-analysis showed no significant difference among the three body weight support training methods for improving lower extremity motor scores in patients with spinal cord injury. The best probability ranking of the body weight support training methods for improving lower extremity motor scores in patients with spinal cord injury was robot-assisted gait training ( P = 0.60), followed by aquatic exercise ( P = 0.21) and body weight support training ( P = 0.19). Body weight support training can improve lower extremity motor score in patients with spinal cord injury. No significant difference was observed among the three body weight support training methods, but robot-assisted gait training may produce the best effect.

Patient and procedural risk factors for decline in lower-extremity motor scores following adult spinal deformity surgery.

The purpose of this study was to discern factors that differentiate patients who experience postoperative lower-extremity motor function decline in the early postoperative period. Adult spinal deformity (ASD) patients who were enrolled in a multicenter, observational, and prospectively collected study from 2018 to 2021 at 18 spinal deformity centers in North America were queried. Eligible participants met at least one of the following radiographic and/or procedural inclusion criteria: pelvic incidence minus lumbar lordosis (PI-LL) ≥ 25°, T1 pelvic angle (T1PA) ≥ 30°, sagittal vertical axis (SVA) ≥ 15 cm, thoracic scoliosis ≥ 70°, thoracolumbar scoliosis ≥ 50°, global coronal malalignment ≥ 7 cm, 3-column osteotomy, spinal fusion ≥ 12 levels, and/or age ≥ 65 years with ≥ 7 levels of instrumentation. Patients with an inflammatory or autoimmune disease and those who were incarcerated or pregnant were excluded, as were non-English speakers. Only patients with baseline and 6-week postoperative lower-extremity motor score (LEMS) were analyzed. Patient information, including demographic data, operative data, patient-reported outcomes, and radiographic parameters, were collected. Univariate and multivariable logistic regression models were built to quantify the degree to which a patient's postoperative LEMS decline was related to demographic and clinical characteristics. In total, 205 patients (mean age 61.5 years, mean total instrumented levels 12.6, 67.3% female, 54.2% primary cases, 79.5% with pelvic fixation) were evaluated. Of these 205 patients, 32 (15.5%) experienced LEMS decline in the perioperative period. These patients were older (p = 0.0014) and had greater BMI (p = 0.0176), higher frailty scores (p = 0.047), longer operating room times (p = 0.033), and greater estimated blood loss (p < 0.0001), and they were more frequently observed to have intraoperative neurophysiological monitoring (IONM) changes (p = 0.018). The deteriorated cohort had greater C7SVA at baseline (p = 0.0028) but were comparable in terms of all other radiographic parameters. No radiographic differences were seen between the groups at the 6-week visit; however, the deteriorated cohort experienced greater change in PI-LL (p < 0.0001), lumbar lordosis (p = 0.0461), C7SVA (p = 0.0004), and T1PA (p < 0.0001). Multivariate logistic regression demonstrated that the presence of IONM changes and each degree of negative change in T1PA conferred 3.71 (95% CI 1.01-13.42) and 1.09 (1.01-1.19) greater odds of postoperative LEMS deterioration, respectively. In this study, 15.6% of ASD patients incurred LEMS decline in the perioperative period. The magnitude of change in global sagittal alignment, specifically T1PA, was the strongest independent predictor of LEMS decline, which has implications for surgical planning, patient counseling, and clinical research.

Countermovement Jumps Detect Subtle Motor Deficits in People with Multiple Sclerosis below the Clinical Threshold.

In the early stages of multiple sclerosis (MS), there are currently no sensitive assessments to evaluate complex motor functions. The countermovement jump (CMJ), a high-challenge task in form of a maximal vertical bipedal jump, has already been investigated as a reliable assessment in healthy subjects for lower extremity motor function. The aim was to investigate whether it is possible to use CMJ to identify subthreshold motor deficits in people with multiple sclerosis (pwMS). All participants (99 pwMS and 33 healthy controls) performed three maximal CMJs on a force plate. PwMS with full motor function and healthy controls (HC) did not differ significantly in age, disease duration, Body Mass Index and the Expanded Disability Scale Score. In comparison to HC, pwMS with full motor function demonstrated a significantly decreased CMJ performance in almost all observed kinetic, temporal and performance parameters (p < 0.05). With increasing disability in pwMS, it was also observed that jump performance decreased significantly. This study showed that the CMJ, as a high challenge task, could detect motor deficits in pwMS below the clinical threshold of careful neurological examination. Longitudinal studies are pending to evaluate whether the CMJ can be used as a standardized measure of disease progression.

Long-Term Lower Limb Motor Function Correlates with Middle Cerebellar Peduncle Structural Integrity in Sub-Acute Stroke: A ROI-Based MRI Cohort Study

Crossed cerebellar diaschisis (CCD) has been widely investigated in patients with supratentorial stroke. However, the role of CCD in lower limb recovery after stroke is still unknown. In this study, using a region-of-interest-based analysis of diffusion tensor imaging (DTI), a total of 44 cases of stroke within 3 months onset were enrolled for assessment of the cerebral peduncle (CP) and middle cerebellar peduncles (MCP) in CCD. Compared with the control group, the fractional anisotropy ratio (rFA) and laterality index (LI) of the CP and MCP in the stroke group significantly decreased. The rFA of the MCP (unaffected side/affected side) showed a more significant correlation with 1-year paresis grading (PG), lower extremity PG, upper extremity PG, National Institutes of Health Stroke Scale (NIHSS), and functional independence measure (FIM) motor item score, in comparison to the rFA of the CP (affected side/unaffected side) (r = -0.698 vs. r = -0.541, r = -0.651 vs. r = -0.386, r = -0.642 vs. r = -0.565, r = -0.519 vs. r = -0.403, and r = 0.487 vs. r = 0.435, respectively). Furthermore, the LI of the CP had a more significant association with 1-year Brunel Balance Assessment (BBA), upper extremity PG, and Modified Rankin Scale (mRS) as compared to the LI of the MCP (r = 0.573 vs. r = 0.452; r = -0.554 vs. r = -0.528; and r = -0.494 vs. r = -0.344, respectively). We set the cutoff point for the MCP rFA at 0.925 (sensitivity: 79% and specificity: 100%) for predicting lower extremity motor function prognosis and found the receiver operating characteristic (ROC) curve of MCP rFA was larger than that of CP rFA (0.893 vs. 0.737). These results reveal that the MCP may play a significant role in the recovery of walking ability after stroke.

Spinal epidural lipomatosis in a pediatric patient with a malignant brain tumor: illustrative case.

Spinal epidural lipomatosis (SEL) in pediatric patients with concomitant malignant brain neoplasms is rare and can present with rapid deterioration in neurological function. A 4-year-old boy with SEL became paraplegic 4 months after completion of chemoradiation for his previously resected, intracranial atypical teratoid rhabdoid tumor. The patient presented with rapid deterioration in lower extremity sensory and motor function, which, given his oncological history, was concerning for disease progression. Of note, 8 months prior, the patient was started on corticosteroid therapy for respiratory dysfunction. Magnetic resonance imaging revealed significant progression of lumbosacral SEL requiring surgical decompression with subsequent neurological improvement. When evaluating pediatric patients with primary or metastatic brain tumors with new or worsening myelopathy and motor or sensory deficits, it is important to consider SEL.

Balance Training with Weight Shift-Triggered Electrical Stimulation for Stroke Patients: A Randomized Controlled Trial.

This study aimed to determine the effects of balance training with weight shift-triggered electrical stimulation to improve balance, lower-extremity motor function, and activities of daily living in patients with stroke. The participants were randomly allocated to the balance training with electrical stimulation group (BT-ESG, n = 29) or the balance training group (BTG, n = 30). Both groups were trained 5 times per week for 6 weeks for 50 min per session. To evaluate static balance, postural sway was assessed and dynamic balance was assessed using the Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and functional reach test (FRT). Lower-extremity motor function was assessed using the Fugl-Meyer assessment. Daily activities were assessed using the Modified Barthel Index. As for static balance, BT-ESG showed a significant improvement compared to BTG in postural swat in both the eyes-open (velocity moment; effect size, 0.88; 95% confidence interval, -1.16 to -1.30), or eyes-closed state (velocity moment; effect size, 0.81; 95% confidence interval, -1.22 to -0.27). Dynamic balance, which includes TUG (effect size, 0.90; 95% confidence interval, -4.67 to -1.25), BBS (effect size, 1.26; 95% confidence interval, -2.84 to 6.83), and FRT (effect size, 1.45; 95% confidence interval, 1.92 to 4.08), in addition to lower-extremity motor function (effect size, 1.38; 95% confidence interval, 2.25 to 4.97), and activities of daily living (effect size, 2.04; 95% confidence interval, 2.04 to 937), showed significant improvement in BT-ESG compared to BTG. These results suggest that balance training with weight shift-triggered electrical stimulation effectively improves balance, lower-extremity motor function, and activities of daily living in patients with stroke.

Effect of Core Exercises on Motor Function Recovery in Stroke Survivors with Very Severe Motor Impairment

Paresis of the upper and lower limbs is a typical issue in stroke survivors. This study aims to determine whether core exercises help stroke survivors with very severe motor impairment recover their motor function. This study employed a within-subjects design. Eleven hemiparetic stroke patients with very severe motor impairment (FMA score < 35) and ages ranging from 24 to 52 years old were enrolled in this study. All participants engaged in supervised core exercise training twice a week for 12 weeks. The main outcome measures were Fugl-Meyer Assessment Lower Extremity (FMA-LE) and Fugl-Meyer Assessment Upper Extremity (FMA-UE), which were measured before training and at intervals of four weeks during training. Repeated measures ANOVA was used to analyze the effect of core exercises on motor function performance and lower extremity motor function and upper extremity motor function recovery. There were significant differences in the mean scores for motor function performance, lower extremity motor function, and upper extremity motor function throughout the four time points. A post-hoc pairwise comparison using the Bonferroni correction revealed that mean scores significantly increased and were statistically different between the initial assessment and follow-up assessments four, eight, and twelve weeks later. This study suggests that 12 weeks of core exercise training is effective for improving motor function recovery in patients with very severe motor impairment.