Lower Limb Motor Dysfunction Research Articles

Effect of Whole-Body Vibration Versus Rhythmic Auditory Stimulation on Spasticity, Balance, and Lower Limb Motor Function in Hemiplegic Stroke Patients

Background: Stroke can lead to spasticity, balance impairments, and lower limb motor dysfunction. Whole-body vibration (WBV) and rhythmic auditory stimulation (RAS) are two therapeutic interventions that may address these deficits.Objective: To compare the effects of WBV and RAS on spasticity, balance, and lower limb motor function in hemiplegic stroke patients.Methods: A single-blinded, randomized controlled trial was conducted with 104 chronic hemiplegic stroke patients, divided into two groups: Group A (WBV) and Group B (RAS). WBV was applied using a vibration platform at 30-40 Hz for 3-minute sessions, 3 days/week for 4 weeks. RAS involved 90-minute sessions of music-based exercises, incorporating rhythmic cues and conventional therapy, 3 days/week for 4 weeks. Spasticity, balance, and motor function were assessed using the Modified Ashworth Scale, Berg Balance Scale, and Fugl-Meyer Assessment, respectively. Data were analyzed using SPSS version 27.Results: Group A showed greater improvements in spasticity (MAS: 1.2±0.4 vs. 2.6±0.3), balance (BBS: 49±5 vs. 43±5), and motor function (FMA: 29±5 vs. 18.5±5) compared to Group B (p<0.05).Conclusion: WBV is more effective than RAS in improving spasticity, balance, and motor function in chronic hemiplegic stroke patients.

Development and Analysis of a Novel Bio-syncretic Parallel Hip Exoskeleton Based on Torque Requirements

Abstract This paper presents a novel bio-syncretic parallel hip exoskeleton (BsPH-Exo) to address the rehabilitation exercise needs of individuals with lower limb motor dysfunction. BsPH-Exo has six degrees of freedom and can generate all three kinds of rotations that the hip joint can naturally realize. BsPH-Exo effectively solves the problem of misalignment between human and exoskeleton joints, eliminating the need for patients to perform any alignment operations. Considering the varying maximum torque requirements for hip joint rehabilitation in different directions, the limbs of BsPH-Exo are specially arranged to ensure that the maximum torque provided by BsPH-Exo in each direction follows the same law as that of the required torque. As a result, BsPH-Exo exhibits excellent output torque performance, specifically in the flexion/extension direction. Moreover, BsPH-Exo demonstrates weak coupling characteristics in the flexion/extension direction and decoupling characteristics in the adduction/abduction direction, which reduces the difficulty in its control. Compared to currently available parallel hip exoskeletons, BsPH-Exo has several distinct advantages that make it particularly well-suited for rehabilitation applications.

Multi-layer CNN-LSTM network with self-attention mechanism for robust estimation of nonlinear uncertain systems.

With the help of robot technology, intelligent rehabilitation of patients with lower limb motor dysfunction caused by stroke can be realized. A key factor constraining the clinical application of rehabilitation robots is how to realize pattern recognition of human movement intentions by using the surface electromyography (sEMG) sensors to ensure unhindered human-robot interaction. A multilayer CNN-LSTM prediction network incorporating the self-attention mechanism (SAM) is proposed, in this paper, which can extract and learn the periodic and trend characteristics of the sEMG signals, and realize the accurate autoregressive prediction of the human motion information. Firstly, the multilayer CNN-LSTM network utilizes the CNN layer for initial feature extraction of data, and the LSTM network is used to improve the enhancement of the historical time-series features. Then, the SAM is used to improve the global feature extraction performance and parallel computation speed of the network. In comparison with existing test is carried out using actual data from five healthy subjects as well as a clinical hemiplegic patient to verify the superiority and practicality of the proposed algorithm. The results show that most of the model's prediction R > 0.9 for different motion states of healthy subjects; in the experiments oriented to the motion characteristics of patient subjects, the angle prediction results of R > 0.99 for the untrained data on the affected side, which proves that our proposed model also has a better effect on the angle prediction of the affected side. The main contribution of this paper is to realize continuous motion estimation of ankle joint for healthy and hemiplegic individuals under non-ideal conditions (weak sEMG signals, muscle fatigue, high muscle tension, etc.), which improves the pattern recognition accuracy and robustness of the sEMG sensor-based system.

Long-Term Outcomes of Infantile Sacrococcygeal Teratoma: Results from a Multi-Institutional Retrospective Observational Study in Japan

BackgroundTumor recurrence, anorectal and urinary dysfunction, and lower limb dysfunction after surgery are observed in infantile sacrococcygeal teratoma (SCT). In this paper, a multi-institutional retrospective observational study was conducted to clarify the long-term functional prognosis in Japan. MethodsThis study was conducted using a paper-based questionnaire distributed to 192 facilities accredited by the Japanese Society of Pediatric Surgeons, covering patients who underwent radical surgery at less than 1 year old and who survived for at least 180 days after birth from 2000 to 2019. ResultsA total of 355 patients were included in this analysis. Altman type was I-II in 248 and type III-IV in 107, and the median maximum tumor diameter was 6.1 (range: 0.6–36.0) cm. There were 269 mature teratomas, 69 immature teratomas, and 10 malignant tumors. Total resection was performed in 325, subtotal or partial resection in 27, and surgical complications were noted in 54. The median postoperative follow-up was 6.6 (0.5–21.7) years. Eighty-three patients (23.4 %) had functional sequelae, including 62 (17.5 %) with anorectal dysfunction, 56 (13.0 %) with urinary dysfunction, and 15 (4.2 %) with lower limb motor dysfunction. Recurrence occurred in 42 (11.8 %) at a median age of 16.8 (1.7–145.1) months old. Risk factors for dysfunction included preterm delivery, a large tumor diameter, Altman type III-IV, incomplete resection, and surgical complications. Risk factors for recurrence included immature teratoma or malignancy, incomplete resection, and surgical complications. ConclusionsPostoperative dysfunction was not low at 23.4 %, and 11.8 % of the patients experienced recurrence occurring more than 10 years after surgery, suggesting the need for periodic imaging and tumor markers evaluations in patients with risk factors. It is necessary to establish treatment guidelines for best practice monitoring of the long-term quality of life. Level of evidenceLevel II Retrospective Study.

Role of Lumbar Sympathetic Block in Linezolid Induced Peripheral Neuropathy With Lower Limb Motor Dysfunction

Role of Lumbar Sympathetic Block in Linezolid Induced Peripheral Neuropathy With Lower Limb Motor Dysfunction

COMPARISION OF TWO DIFFERENT RADIO THERAPY FRACTIONATIONS FOR METASTATIC SPINAL CORD COMPRESSION

Background: Indian population experiences most common cancers of Lung, Breast, prostate most commonly where the disease is systemic to start with, and a high chance of metastasis to bones. Our institute experience most common radiotherapy emergency of cord compression so regularly that we need to frame a protocol for this cases on priority and the linac machine time is also so precious. Objectives: To compare the overall response in patients treated with two different fractionation schedules of 4 Gy x 5 fractions versus 3 Gy x 10 fractions for metastatic spinal cord compression. Materials and Methods: It is a prospective comparative study with total number of patients enrolled in the study is 60. After obtaining informed consent, then patients were enrolled in the study. Patients with known biopsy proven tumour presenting with metastatic spinal cord compression causing lower limb motor dysfunction. Results: Results of the study showed that overall response to radiation and ambulatory status of patients post irradiation were similar in both arms. There was no significant difference between the arms. Conclusion: Comparatively no difference in over all response and ambulatory status of patient by different fractionation. In general patients with MSCC have a poor survival and short course fractionation with 4 Gy x 5 fractions can be considered instead of the standard 3 Gy x 10 fractions.

Facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury caused by closed temporal bone fractures

To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures. Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups ( P>0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins et al. Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups ( t=5.693, P=0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group. Facial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.

Development and Application of A New Graphene Sensing Exoskeleton Device System for Lower Extremity Walking

In view of the phenomenon that the exoskeleton lower limb walking robot is insensitive and wears less compliance, this project proposes the idea of using wearable sensors composed of graphene and its composite materials to realize the lower limb exoskeleton system. Through the lower limb joint movement mechanism combined with the feature of gait analysis, the design is consistent with human body engineering and meet the demand of rehabilitation in patients with lower limb joints more flexible exoskeleton, using graphene excellent mechanical properties and unique electrical characteristics, and material as the ideal two-dimensional structure, realizes the flexibility design of the sensor and preparation, and further perfect the wearable sensor through visual sensor, Various physiological signals of the human body are monitored to help lower extremity X bone aid meet the needs of patients. The multi-modal signals collected during the gait of the subjects are combined with machine learning methods to achieve accurate identification of the motion intention of patients. Meanwhile, gait parameters are analyzed to facilitate real-time adjustment of the robot. Finally, we hope to provide effective means for the rehabilitation of patients with lower limb motor dysfunction.

Development and Evaluation of a Rehabilitation Wheelchair with Multiposture Transformation and Smart Control

Stroke and other neurological disorders have an effect on mobility which has a significant impact on independence and quality of life. The core rehabilitation requirements for patients with lower limb motor dysfunction are gait training, restand, and mobility. In this work, we introduce a newly developed multifunctional wheelchair that we call “ReChair” and evaluated its performance preliminarily. ReChair seamlessly integrates the mobility, gait training, and multiposture transformation. ReChair driving and multiposture transformation are done using the voice, button, and mobile terminal control. This work describes the functional requirements, mechanical structure, and control system and the overall evaluation of ReChair including the kinematic simulation of the multiposture transformation and passive lower limb rehabilitation training to quantitatively verify the motion capability of ReChair, the voice control system evaluation that shows how the voice recognition system is suitable for home environment, the sensorless speed detection test results that indicate how the wheel speeds measured by sensorless method are appropriate for travelling control, and the passive and balance training test results that show how the lower limb rehabilitation training in daily life by ReChair is convenient. Finally, the experimental results show that ReChair meets the patients’ requirements and has practical significance. It is cost-effective, easy to use, and supports multiple control modes to adapt to different rehabilitation phases.

Studies on 11 Cases of Spinal Epidural Abscess and Literature Review.

ObjectiveIn the present study, we aimed to describe the clinical features, diagnosis, treatment, and prognosis of spinal epidural abscess (SEA).MethodsThe complete clinical data of 11 SEA patients who were treated in our hospital system from January 2015 to June 2018 were retrospectively analyzed. Moreover, the clinical features, diagnosis, treatment, and prognosis of 642 SEA cases collected from the foreign literature from 2010 to 2019 were also investigated.ResultsAmong our 11 SEA patients, nine cases had purulent inflammation, two cases had tuberculosis, two cases had infection caused by Staphylococcus aureus, one case had infection caused by Streptococcus constellatus, one case had infection caused by Klebsiella pneumoniae, five cases showed negative bacterial culture, and two cases had Mycobacterium tuberculosis. All 11 cases showed focal spinal pain, eight cases exhibited neurological deficits, and six cases experienced fever. Nine of the 11 cases involved the lumbosacral spine, one case involved the thoracic spine, and one case involved the cervical spine. Eight patients had a longer course of disease (>2 weeks), all 11 patients had vertebral osteomyelitis, and nine patients had intervertebral discitis. One patient had motor dysfunction of arms and legs, one patient had lower limb motor dysfunction, one patient had limb numbness, one patient experienced relapse after the conservative treatment, and one patient experienced relapse after the surgical treatment. The follow-up time was 15–24 months.ConclusionThe classic diagnosis of triads (focal spine pain, neurological deficit, and fever) was less specific for SEA. MRI examination, blood culture, tissue culture, and biopsy could be used for the diagnosis for SEA. Suppuritis was a common cause of SEA. Early detection, early diagnosis and early treatment, as well as the selection of the most suitable treatment regimen based on comprehensive evaluation, played crucial roles in a better prognosis of SEA. There was no statistically significant difference in terms of the general condition, diagnosis, treatment and prognosis between the patients with negative and positive culture results (P>0.05). For SEA patient with negative culture, antibiotic treatment should be used empirically.

Research on the Motion Control Trajectory and Structure Design of a Lower Limb Standing Rehabilitation Training Device

Aiming at the problem of standing rehabilitation of lower limb motor dysfunction patient. Firstly, the standing movement process of human body is analyzed. Secondly, the exercise trajectory test and pressure distribution measurement test of healthy human body are studied. Thirdly, the structure of the lower limb standing rehabilitation training device is designed according to the collected joint trajectory. Finally, the movement control trajectory simulation of the lower limb standing rehabilitation training device is carried out according to the collected regional pressure. The simulation results of virtual prototype coincide with the test trajectory, which shows that the structure of the designed lower limb standing rehabilitation training device is reasonable, and the hybrid control method of force and position can realize the standing rehabilitation training for lower limb motor dysfunction patient in the light of the set exercise trajectory.

Research on Lower Extremity Exoskeleton System Based on Elastic Energy Storage Components

In this paper, we study the field of rehabilitation walker technology. The passive energy storage gravity support exoskeleton is suitable for patients with lower limb dysfunction or limited function caused by lower limb joint, muscle tissue damage or bone disease. The equipment studied in this paper can assist patients to carry out normal ground walking and up and down stairs, realize patient self-care, slow down the patient’s physiological pain, and reduce the economic and energy burden of the patient’s family members. As the proportion of the elderly population continues to rise, the physiological decline during the aging process makes the elderly’s limbs less flexible, with limb motor dysfunction and lower limb motor dysfunction. Manual laborers have long been engaged in labor with repetitive and long working hours. It is easy to cause occupational chronic musculoskeletal injuries or other occupational diseases by maintaining the same or improper working posture for a long time.

Effects of Transcranial Direct Current Stimulation and Peripheral Stimulation on Electrical Activity of the Tibialis Anterior Muscle and Balance in Stroke Survivors with Hemiparesis – Randomized, Sham-Controlled, Double-Blind, Clinical Trial

Lower limb motor dysfunction and lack of balance is one of the most common and disabling sequelae affecting stroke. Objectives: Analyze the effects of the combination of Transcranial Direct Stimulation (tDCS) with peripheral stimulation (PES) on the activity of the tibialis anterior (TA) paretic and balance of hemiparetic post stroke.

Voice controlled wheelchair integration rehabilitation training and posture transformation for people with lower limb motor dysfunction.

Stroke and other neurological disorders have an effect on mobility, which has a significant impact on independence and quality of life. The core rehabilitation requirements for patients with lower limb motor dysfunction are gait training, re-stand and mobility. A wheelchair called ReChair was invented that seamlessly integrated mobility, gait training and multi-posture transformation with voice control. The mechanical structure and control system of ReChair were designed. The overall evaluation included voice recognition and balance training test to quantitatively verify the performance of ReChair. The average success recognition rate of posture transformation by voice control can reach 91% to 96% in a quiet environment (20-30 DB). The balance training game is easy to operate and the score can be used as a quantified guideline for rehabilitation. The proposed rehabilitation wheelchair can realize multi-posture transformation and balance training by the voice control system.

Real-world clinical course of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in Japan

BackgroundAs human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a rare chronic neurological disease, large scale studies to collect continuous clinical data have been difficult to conduct. Therefore, the incidence of comorbidities and drug utilization data remain unknown. When conducting trials to develop new drugs in rare disease such as HAM/TSP, historical control data obtained from registry studies would be useful, as cohorts in rare disease tend to be small. Long-term follow-up of patients with a chronic disease can also be challenging. In this study, we addressed the following two goals using registry data on patients (n = 486) enrolled in the Japanese HAM/TSP patient registry “HAM-net” from 2012 to 2016: 1) to clarify the epidemiological information of HAM/TSP such as the incidence of comorbidities and drug utilization and 2) to provide the real-world data on changes in lower limb motor dysfunction.ResultsIn HAM-net-registered patients, common comorbidities were fractures, herpes zoster, and uveitis, with incidences of 55.5, 10.4, and 6.5, respectively, per 1000 person-years. Every year, oral steroid treatment was administered in 48.2–50.7% of the HAM-net-registered patients and interferon-α treatment was used in 2.6–3.5% of patients. The median dose of oral prednisolone was low at 5.0 mg/day. The incidence of fractures and herpes zoster tended to be higher in the steroid-treated group than in the untreated group (fractures: 61.0 vs. 48.3, herpes zoster: 12.7 vs. 8.8, per 1000 person-years). The analysis of chronological change in Osame motor disability score (OMDS) indicated that the mean change in OMDS was + 0.20 [95% confidence intervals (CI): 0.14–0.25] per year in the one-year observation group (n = 346) and + 0.57 (95% CI: 0.42–0.73) over four years in the four-year observation group (n = 148). Significant deterioration of OMDS was noted in all subgroups with varying steroid use status.ConclusionsThis study revealed the incidence of comorbidities and drug utilization data in patients with HAM/TSP using registry data. Furthermore, this study provided real-world data on chronological changes in lower limb motor dysfunction in patients with HAM/TSP, indicating the utility of these data as historical controls.

Simultaneous Recognition and Assessment of Post-Stroke Hemiparetic Gait by Fusing Kinematic, Kinetic, and Electrophysiological Data.

Gait analysis for the patients with lower limb motor dysfunction is a useful tool in assisting clinicians for diagnosis, assessment, and rehabilitation strategy making. Implementing accurate automatic gait analysis for the hemiparetic patients after stroke is a great challenge in clinical practice. This study is to develop a new automatic gait analysis system for qualitatively recognizing and quantitatively assessing the gait abnormality of the post-stroke hemiparetic patients. Twenty-one post-stroke patients and twenty-one healthy volunteers participated in the walking trials. Three of the most representative gait data, i.e., marker trajectory (MT), ground reaction force (GRF), and electromyogram, were simultaneously acquired from these subjects during their walking. A multimodal fusion architecture is established by using these different modal data to qualitatively distinguish the hemiparetic gait from normal gait by different pattern recognition techniques and to quantitatively estimate the patient's lower limb motor function by a novel probability-based gait score. Seven decision fusion algorithms have been tested in this architecture, and extensive data analysis experiments have been conducted. The results indicate that the recognition performance and estimation performance of the system become better when more modal gait data are fused. For the recognition performance, the random forest classifier based on the GRF data achieves an accuracy of 92.26% outperformed other single-modal schemes. When combining two modal data, the accuracy can be enhanced to 95.83% by using the support vector machine (SVM) fusion algorithm to fuse the MT and GRF data. When integrating all the three modal data, the accuracy can be further improved to 98.21% by using the SVM fusion algorithm. For the estimation performance, the absolute values of the correlation coefficients between the estimation results of the above three schemes and the Wisconsin gait scale scores for the post-stroke patients are 0.63, 0.75, and 0.84, respectively, which means the clinical relevance becomes more obvious when using more modalities. These promising results demonstrate that the proposed method has considerable potential to promote the future design of automatic gait analysis systems for clinical practice.

Effect of acupuncture and tuina plus rehabilitative therapy on lower limb motor dysfunction in infants with spastic cerebral palsy

To observe the effect of acupuncture, tuina plus rehabilitative therapy on lower limb motor dysfunction in infants with spastic cerebral palsy. A total of 60 infants with spastic cerebral palsy were randomly divided into a treatment group and a control group by random digital table, 30 cases in each group. The treatment group was treated with acupuncture, tuina therapy plus rehabilitative therapy of Western medicine. The control group was simply treated with rehabilitative therapy of Western medicine, as same as that for the treatment group. The assessment was respectively given to the sick infants before the treatment and after the treatment of six months, to evaluate lying and rolling scores in dimension A, to evaluate sitting score in dimension B, to evaluate crawling and kneeling scores in dimension C, and evaluate standing score in dimension D in the gross motor functions and determine the muscle tone of the gastrocnemius muscle by modified Ashworth scale (MAS). The differences were not statistically significant in comparison of the gross motor functions and the muscle tone of the gastrocnemius muscle between the two groups of sick infants before the treatment (P>0.05); after the treatment of six months, the above items were obviously improved in the two groups (P<0.01), better in the treatment group than in the control group, with the statistical significance in the differences between the groups (P<0.01). Acupuncture, tuina plus rehabilitative therapy of Western medicine are remarkable in the therapeutic effects in the treatment of motor disorders of the lower limbs in the sick infants with spastic cerebral palsy. This therapeutic method is safe, simple and convenient and needs to be clinically popularized and applied.