Performance Of Stroke Survivors Research Articles

Goal conceptualization has distinct effects on spatial and temporal bimanual coordination after left- and right- hemisphere stroke

Perception of task goal influences motor performance and coordination. In bimanual actions, it is unclear how one's perception of task goals influences bimanual coordination and performance in individuals with unilateral stroke. We characterized inter-limb coordination differences in individuals with chronic right- and left-hemisphere damaged (RCVA: n = 24, LCVA: n = 24) stroke and age-matched neurotypical controls (n = 24) as they completed bimanual reaching tasks under distinct goal conditions. In the dual-goal condition, participants reached to move two virtual bricks (cursors) assigned to each hand toward independent targets. In the common-goal condition, they moved a central common virtual brick representing both hands to a single, central target. Spatial and temporal coordination (cross-correlation coefficients of hand velocity and their time-lag), the redundant axis deviations (the hand deviations in the axis orthogonal to the axis along the cursor-target direction), and the contribution ratio of the paretic hand were measured. Compared to the dual-goal condition, reaching actions to the common-goal demonstrated better spatial bimanual coordination in all three participant groups. Temporal coordination was better during common-goal than dual-goal actions only for the LCVA group. Additionally, and novel to this field, sex, as a biological variable, differently influenced movement time and redundant axis deviation in participants with stroke under the common-goal condition. Specifically, female stroke survivors showed larger movements in the redundant axes and, consequently, longer movement times, which was more prominent in the LCVA group. Our results indicate that perception of task goals influences bimanual coordination, with common goal improving spatial coordination in neurotypical individuals and individuals with unilateral stroke and providing additional advantage for temporal coordination in those with LCVA. Sex influences bimanual performance in stroke survivors and needs to be considered in future investigations.

Impact of Hand Grip Strength on Functional Independence and Arm Motor Performance in Stroke Survivors

Background: Stroke remains a leading cause of disability worldwide, with a significant number of survivors experiencing impairments in upper limb function and hand grip strength, which are crucial for performing activities of daily living (ADLs). Understanding the relationship between hand grip strength, functional independence, and arm motor performance is essential for optimizing rehabilitation strategies. Objective: This study aimed to investigate the impact of hand grip strength on functional independence and arm motor performance in stroke survivors and to evaluate the effectiveness of Mirror Therapy in enhancing these outcomes. Methods: An analytical cross-sectional study was conducted at DHQ Teaching Hospital Sargodha, involving 22 stroke survivors, evenly split between genders. Participants were aged 45-65 years, clinically diagnosed with ischemic stroke in the subacute stage, and exhibited Modified Ashworth Scale scores of 1 to 1+ for hand flexors. The study employed randomized assignments to intervention groups, utilizing assessments such as the Action Research Arm Test (ARAT), Fugl-Meyer Assessment for Upper Extremity (FMA UE), Hand-Held Dynamometer (HHD), and Stroke Impact Scale (SIS) at baseline, 3 weeks, and 6 weeks. Statistical analysis was performed using Pearson’s coefficient of correlation with SPSS version 25. Results: Significant improvements were observed in upper limb strength and hand dexterity, particularly in the group undergoing Mirror Therapy. The correlation coefficients among ARAT, HHD, and SIS were .676**, .748**, and .704** respectively, indicating strong positive relationships between hand grip strength, functional ability, and quality of life. Mirror Therapy demonstrated notable enhancements in ARAT (p = .001), FMA UE (p < .000), HHD (p = .000), and SIS scores (p = .000), reflecting increased functional ability, grip strength, and improved quality of life. Conclusion: The study confirmed the significant impact of hand grip strength on the functional independence and arm motor performance of stroke survivors, with Mirror Therapy providing substantial benefits. These findings advocate for the inclusion of grip strength-focused interventions and Mirror Therapy in stroke rehabilitation programs to improve survivors' functional outcomes and quality of life.

Abstract TP88: The Role of Tele-Occupational Therapy to Facilitate Occupational Performance in Stroke Survivors Selected by Patient Reported Outcomes

After a stroke, coming back home is difficult for most stroke patients. Occupational Therapy (OT) promotes coping with this situation, but in-home intervention is scarce. Through patient reported outcomes (PROMs), an OT can detect possible needs in the areas of occupational performance (OP), and then provide the appropriate tools to facilitate occupation in areas of self-care, productivity and leisure. We aimed to evaluate a tele-OT intervention through a holistic app to provide OT after discharge from a comprehensive stroke center. Methods: Consecutive stroke patients discharged home were included in a multimodal digital follow-up program (NORA) through a mobile application validated for communication, education, adherence, risk factors control and PROMs/PREMs recollection. Patients with OT needs are offered a telematic visit to solve stroke-related doubts, everyday activities, home modifications promoting patient’s autonomy and self-care. A tele-OT satisfaction questionnaire (teleOT-PREM) was recollected. Results: Over two years, 993 patients were included in NORA follow-up and reported PROMs at 7-30 days. 147 (14.8%) patients presented OT needs and were included in our tele-OT intervention. Sixty-one were men, with a mean age of 68.5y and a median mRS of 2 at hospital discharge. Tele-OT patients reported worse PROMs than the global series: in HADS, 40.8% anxiety and 34.2% depression and in PROMIS-10 89.3% altered mental health and 82.1% altered physical health, as compared with 13.1%, 17.7%, 64.7%, and 54.8% respectively (p<0.001) 108 patients answered the teleOT-PREM. The median usefulness of intervention (in a scale from 0-10) was 8.2 and 65% reported being “very satisfied” with the visit. Conclusion: Stroke has a direct impact on a person’s occupational performance. Follow-up by an expert of the occupation (OT) could help to identify the post-stroke patient’s needs and poor PROMs can be used as a selection tool. Tele-OT intervention may promote a better OP, facilitating the daily life activities and improving the quality of life. Tele-OT intervention was feasible and considered useful for most of our stroke patients with OT requirements.

Different aspects of hand grip performance associated with structural connectivity of distinct sensorimotor networks in chronic stroke.

Knowledge regarding the neural origins of distinct upper extremity impairments may guide the choice of interventions to target neural structures responsible for specific impairments. This cross-sectional pilot study investigated whether different brain networks explain distinct aspects of hand grip performance in stroke survivors. In 22 chronic stroke survivors, hand grip performance was characterized as grip strength, reaction, relaxation times, and control of grip force magnitude and direction. In addition, their brain structural connectomes were constructed from diffusion tensor MRI. Prominent networks were identified based on a two-step factor analysis using the number of streamlines among brain regions relevant to sensorimotor function. We used regression models to estimate the predictive value of sensorimotor network connectivity for hand grip performance measures while controlling for stroke lesion volumes. Each hand grip performance measure correlated with the connectivity of distinct brain sensorimotor networks. These results suggest that different brain networks may be responsible for different aspects of hand grip performance, which leads to varying clinical presentations of upper extremity impairment following stroke. Understanding the brain network correlates for different hand grip performances may facilitate the development of personalized rehabilitation interventions to directly target the responsible brain network for specific impairments in individual patients, thus improving outcomes.

Exploration of arm weight effects on hemiparetic stroke participants' gait performance

BackgroundThis study explores the potential benefits of an arm weight intervention for improving gait performance in stroke survivors. Consistent with an interlimb neural coupling mechanism, the investigators hypothesized that arm weight would improve gait performance. MethodsNine stroke and nine healthy participants (1 female; age: 58.0 ± 6.8 years) participated. Participants walked over-ground at their preferred speed in four conditions: no weight (C1), non-hemiparetic (healthy: dominant) side weights (C2), hemiparetic (non-dominant) side weights (C3), and bilateral weights (C4). Statistical analyses included repeated analysis of variance (ANOVA) and paired t-test planned comparisons to explore the effects of added weight on gait speed, step width, step length, cadence, and arm swing amplitude. Single-subject analyses used randomization tests to delineate further the weight's effect on gait speed. FindingsThe stroke group walked significantly faster with arm weight (p = 0.048), exhibiting large ANOVA (η2p = 0.28) and C1 vs. C4 planned comparison (p = 0.021; dD = 0.95) effect sizes. Four of nine stroke participants significantly increased gait speed in at least one condition, and seven of nine exhibited large effect size increases (d = 0.85–4.71). The stroke group's hemiparetic-side step length and cadence significantly (p = 0.008) increased in C4 compared to C1, exhibiting large effect size increases (rb = 0.96). Four of nine healthy participants significantly increased gait speed in at least one condition, with five of nine exhibiting large effect size increases (d = 0.80–6.63). InterpretationThis study's exploratory results demonstrate arm weight's potential for improving higher-functioning stroke survivors' gait performance. Arm weight addition merits further investigation as a possible rehabilitation intervention in the stroke population.

Abstract TP60: Stroke Recovery Using Brain Computer Interface

Introduction: Non-invasive electroencephalographic (EEG) based brain-computer interface (BCI) therapy has been shown to increase upper extremity mobility in stroke survivors with persistent upper extremity motor impairment. Previous studies have shown that in order to evoke movement from a particular motor system, sensory cues are combined in an essentially linear model. That is, the feedback from each sensory system is summed and torque is generated as a function of the summed signal. This subanalysis aims to evaluate the efficacy of EEG-based BCI-functional electrical stimulation (FES). The goal was to determine whether greater sensory feedback improves BCI task performance in stroke survivors with upper extremity motor impairment. Methods: Data were acquired from 31 ischemic stroke patients, with persistent upper extremity motor impairment (mean age = 66 years old, F = 14, M = 17, mean time since stroke onset = 100 months). Participants were kept in one group and all patients received two types of therapies: BCI-only therapy followed by BCI-FES therapy. Participants were instructed to move either their left or right hand to control a virtual cursor in a cursor and target task. A successful trial was recorded if the participant successfully moved the cursor into the target area. The task was first performed with only visual stimulation, then participants received cutaneous stimulation via the paired FES in addition to the visual display of the cursor and target. EEG data was acquired using BCI2000 software and a 16 channel EEG cap. Results: Although improvement was seen for participants when they received BCI therapy as well as when they received BCI-FES therapy, BCI performance scores over time were not significantly different from one another (p = 0.13). The BCI-only and BCI-FES pre-study averages were 5.58 (SD = 1.64) and 5.86 (SD = 1.66) respectively and the post-study averages were 5.99 (SD = 1.41) and 6.33 (SD = 1.75) respectively. Conclusions: For chronic stroke survivors, both BCI visual only and BCI-FES intervention may help promote restoration of upper extremity motor function at similar rates.

The Effect of Implanted Functional Electrical Stimulation on Gait Performance in Stroke Survivors: A Systematic Review.

The emerging literature suggests that implantable functional electrical stimulation may improve gait performance in stroke survivors. However, there is no review providing the possible therapeutic effects of implanted functional electrical stimulation on gait performance in stroke survivors. We performed a web-based, systematic paper search using PubMed, the Cochrane Library, and EMBASE. We limited the search results to human subjects and papers published in peer-reviewed journals in English. We did not restrict demographic or clinical characteristics. We included 10 papers in the current systematic review. Across all included studies, we found preliminary evidence of the potential therapeutic effects of functional electrical stimulation on walking endurance, walking speed, ankle mobility, and push-off force in stroke survivors. However, due to the heterogeneity between the included studies, small sample size, and lack of randomized controlled trials, more studies are critically needed to confirm whether implanted functional electrical stimulation can improve gait performance in stroke survivors.

Brazilian version of the Functional Gait Assessment: translation, reliability, and validity for use on stroke patients

Objective. Translate and adapt the Functional Gait Assessment (FGA) to Brazilian Portuguese as a measure of balance during gait in stroke patients and determine its validity and reliability based on evidence of its measurement properties. Method. A convenience sample of 45 stroke survivors (average of seven months since diagnosis) was included (mean age: 55 years; 51% women). The instrument under consideration was translated and back-translated. The performance of the FGA was assessed by two raters to determine intrarater and interrater reliability. Concurrent and discriminant validity were investigated using the Berg Balance Scale (BBS) as well as normal and fast walking speed. Results. No difficulties with the translation were found during the application of the tests. Therefore, no structural or conceptual changes to the translated version were needed to achieve cultural equivalence. Intrarater (intraclass correlation coefficient=0.93) and interrater reliability (intraclass correlation coefficient=0.90) were almost perfect for the total scores. The reliability of single items was also strong, ranging from 0.74 to 0.95. Concurrent validity with other measures of gait and balance was moderate to substantial. The FGA was correlated (p<0.001) with the BBS (0.71), normal walking speed (0.66), and fast walking speed (0.70). Conclusion. The Brazilian version of the FGA is a reliable, valid instrument for assessing functional gait performance in stroke survivors.

The Kickstart Walk Assist System for improving balance and walking function in stroke survivors: a feasibility study

BackgroundCompared with traditional physical therapy for stroke patients, lower extremity exoskeletons can provide patients with greater endurance and more repeatable and controllable training, which can reduce the therapeutic burden of the therapist. However, most exoskeletons are expensive, heavy or require active power to be operated. Therefore, a lighter, easy to wear, easy to operate, low-cost technology for stroke rehabilitation would be a welcome opportunity for stroke survivors, caregivers and clinicians. One such device is the Kickstart Walk Assist system and the purpose of this study was to determine feasibility of using this unpowered exoskeleton device in a sample of stroke survivors.MethodsThirty stroke survivors were enrolled in the study and experienced walking with the Kickstart exoskeleton device that provided spring-loaded assistance during gait. After 5 days of wearing the exoskeleton, participants were evaluated in the two states of wearing and not wearing the exoskeleton. Outcome measures included: (a) spatio-temporal gait measures, (b) balance measures and (c) exoskeleton-use feedback questionnaire.ResultsIn comparison to not wearing the device, when participants wore the Kickstart walking system, weight bearing asymmetry was reduced. The time spent on the 10-m walk test was also reduced, but there was no difference in the timed-up-and-go test (TUGT). Gait analysis data showed reduction in step time and double support time. Stroke survivors were positive about the Kickstart walking system’s ability to improve their balance, speed and gait. In addition, their confidence level and willingness to use the device was also positive.ConclusionsThese findings show the feasibility of using the Kickstart walking system for improving walking performance in stroke survivors. Our future goal is to perform a longer duration study with more comprehensive pre- and post-testing in a larger sample of stroke survivors.Trial registration Chinese Clinical Trial Registry, ChiCTR2000032665. Registered 5 May 2020—Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=53288

Fronto-parietal involvement in chronic stroke motor performance when corticospinal tract integrity is compromised

BackgroundPreserved integrity of the corticospinal tract (CST) is a marker of good upper-limb behavior and recovery following stroke. However, there is less understanding of neural mechanisms that might help facilitate upper-limb motor recovery in stroke survivors with extensive CST damage. ObjectiveThe purpose of this study was to investigate resting state functional connectivity in chronic stroke survivors with different levels of CST damage and to explore neural correlates of greater upper-limb motor performance in stroke survivors with compromised ipsilesional CST integrity. MethodsThirty chronic stroke survivors (24 males, aged 64.7 ± 10.8 years) participated in this study. Three experimental sessions were conducted to: 1) obtain anatomical (T1, T2) structural (diffusion) and functional (resting state) MRI sequences, 2) determine CST integrity with transcranial magnetic stimulation (TMS) and conduct assessments of upper-limb behavior, and 3) reconfirm CST integrity status. Participants were divided into groups according to the extent of CST damage. Those in the extensive CST damage group did not show TMS evoked responses and had significantly lower ipsilesional fractional anisotropy. ResultsOf the 30 chronic stroke survivors, 12 were categorized as having extensive CST damage. Stroke survivors with extensive CST damage had weaker functional connectivity in the ipsilesional sensorimotor network and greater functional connectivity in the ipsilesional fronto-parietal network compared to those with preserved CST integrity. For participants with extensive CST damage, improved motor performance was associated with greater functional connectivity of the ipsilesional fronto-parietal network and higher fractional anisotropy of the ipsilesional rostral superior longitudinal fasciculus. ConclusionsStroke survivors with extensive CST damage have greater resting state functional connectivity of an ipsilesional fronto-parietal network that appears to be a behaviorally relevant neural mechanism that improves upper-limb motor performance.

A Home-Based, mHealth-Assisted Piano Therapy to Improve Upper Extremity Performance in Stroke Survivors: A Pilot Study

To examine the feasibility of using an iPad mobile app to provide home-based piano therapy post-stroke.

A Home-Based, Mobile-Health-Assisted Piano Therapy to Improve Upper-Extremity Performance in Stroke Survivors: A Pilot Study

Abstract Date Presented 03/27/20 Music therapy has been demonstrated to improve poststroke motor performance. Our preliminary data from a three-week home-based music training suggest that the incorporation of mobile-health technology with piano therapy may provide an effective, acceptable, and motivating in-home training for stroke survivors to regain their motor capability. This research is currently in progress and recruiting more participants to obtain a solid conclusion. Primary Author and Speaker: Yi-An Chen Contributing Authors: Martin Norgaard, Ryan Albright, Emily Buchman, Kinusk Maitra

A randomized controlled trial of motor imagery combined with structured progressive circuit class therapy on gait in stroke survivors

Structured Progressive Circuit Class Therapy (SPCCT) was developed based on task-oriented therapy, providing benefits to patients’ motivation and motor function. Training with Motor Imagery (MI) alone can improve gait performance in stroke survivors, but a greater effect may be observed when combined with SPCCT. Health education (HE) is a basic component of stroke rehabilitation and can reduce depression and emotional distress. Thus, this study aimed to investigate the effect of MI with SPCCT against HE with SPCCT on gait in stroke survivors. Two hundred and ninety stroke survivors from 3 hospitals in Yangon, Myanmar enrolled in the study. Of these, 40 stroke survivors who passed the selection criteria were randomized into an experimental (n = 20) or control (n = 20) group. The experimental group received MI training whereas the control group received HE for 25 minutes prior to having the same 65 minutes SPCCT program, with both groups receiving training 3 times a week over 4 weeks. Temporo-spatial gait variables and lower limb muscle strength of the affected side were assessed at baseline, 2 weeks, and 4 weeks after intervention. After 4 weeks of training, the experimental group showed greater improvement than the control group in all temporospatial gait variables, except for the unaffected step length and step time symmetry which showed no difference. In addition, greater improvements of the affected hip flexor and knee extensor muscle strength were found in the experimental group. In conclusion, a combination of MI with SPCCT provided a greater therapeutic effect on gait and lower limb muscle strengths in stroke survivors.

Technology-Assisted Ankle Rehabilitation Improves Balance and Gait Performance in Stroke Survivors: A Randomized Controlled Study With 1-Month Follow-Up.

Many stroke survivors have limited ankle range of motion (ROM) caused by weak dorsiflexors and stiff plantarflexors. Passive ankle stretching exercises with physical therapists or a stretching board are usually recommended, but these treatments have some limitations (e.g., cost and availability of physical therapists). In this paper, we assessed the results of ankle stretching exercises delivered by a robotic ankle stretching system called motorized ankle stretcher (MAS) that we developed or by a stretching board on ankle ROM, balance control, and gait performance. The 16 stroke survivors were randomly assigned to an intervention group (IG) or a control group (CG) and participated in seven sessions of dorsiflexion stretching exercises for three-and-a-half consecutive weeks. Laboratory assessments included pre-assessment (baseline at the beginning of the first exercise session), post-assessment (at the end of the seventh exercise session), and retention assessment (one month after the seventh exercise session). All assessments included ankle ROM for the affected side, static/dynamic balance control with a sensory organization test (SOT), walking speed, walking cadence, and step length for the affected and unaffected sides. During seven sessions of ankle stretching exercises, the IG performed them using the MAS, and the CG used a stretching board. The IG significantly improved ankle ROM, SOT scores (i.e., static/dynamic balance control), walking speeds, walking cadences, and step lengths for the unaffected side after completing the seven exercise sessions of ankle stretching exercises and maintained the enhancements at the retention assessment. The CG did not significantly improve across the majority of outcome measures except for the SOT scores between the pre-assessment and retention assessment. Future work will investigate the ideal intensity, frequency, and duration of exercising with the MAS. Our research on technology-assisted ankle rehabilitation, which can ascertain the level of persistent improvement, long-term performance retention, and carry-over effects in stroke survivors, can be used to inform future designs.

Effect of sensory-motor training on gait quality and executive functioning of chronic stroke survivors

Traditionally gait was believed to be an automated task; however current research shows that walking involves higher cognitive functions i.e. executive function (EF). Optimal EF allows allocation of appropriate attentional resources to performing motor tasks correctly and effectively and is severely affected in stroke survivors. Limited research has been done on the effectiveness of sensory-motor training (SMT) on cognitive functioning in stroke. It is hypothesized that SMT may improve this motor-cognitive interaction during gait, as well as EF. This study endeavoured to determine if an eight-week SMT programme would influence executive functioning and dual task gait quality in chronic stroke survivors. This pre-post study design consisted of ten chronic stroke survivors (67 ± 14 years; ≥ 6 months since stroke) with no severe cognitive impairment (24 ± 2 score on Montreal Cognitive Assessment) who participated in the eight-week SMT programme, three times a week (45–60 minutes per session) under therapist-supervision. A two-minute walk test assessed single (ST) and dual task (DT) spatial-temporal gait variables; while EF was assessed with an adapted Stroop, Trail Making (Part A and B) and Verbal Digit Span Forward and Backward tests. Stroke-related self-efficacy was determined by completing the Stroke Self-efficacy Questionnaire. No significant changes were found in EF or ST gait variables. DT stride velocity ( P = 0.05, d = 0.39, 95% CI: −11.07 to −0.73), paretic stride velocity ( P = 0.04, d = 0.40, 95% CI: −11.34 to −1.18), cadence ( P = 0.03, d = 0.78, 95% CI: −19.04 to −2.50), stride time ( P = 0.02, d = 0.82, 95% CI: 0.00 to 0.40) and peak medio-lateral trunk acceleration ( P = 0.02, d = 0.45, 95% CI: −5.93 to −1.16) showed improvement. Stroke-related self-efficacy ( P < 0.001; d = 2.66, 95% CI: 1.26 to 4.57) also improved. Preliminary findings suggest that SMT have some benefits for improving cognitive-motor interaction during walking, while also improving factors that specifically influence performance in stroke survivors. Furthermore, studies should investigate the use of DT as an ecological assessment tool for stroke survivor's EF.

Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

ObjectiveThe purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program. MethodsThirty-one post-stroke patients (60.6±12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (Fext, Fflex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test. ResultsThe rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both Fflexkg−1 and Fextkg−1 had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fextkg−1 and, interestingly, even more prominent for Fflexkg−1. ConclusionsMMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors.

Trunk kinematics related to generation andtransfer of the trunk flexor momentum are associated with sit-to-stand performance in chronic stroke survivors.

Stroke subjects show poorer sit-to-stand (STS) performance when compared to matched-healthy subjects, but it is still unclear the trunk role in this poorer performance. To compare the trunk kinematics related to the generation/transfer of the flexor momentum during the STS task between stroke and matched-healthy subjects, and to investigate if there were relationships between these variables and STS performance. Eighteen chronic stroke survivors and 18 matched-healthy subjects were assessed. The score of the five-repetition STS test and the total/phases duration of the STS (motion analysis system) at both self-selected/fast speeds characterized STS performance. Trunk kinematic variables were maximum forward flexion, peak flexor momentum, and its temporal framework in the STS. Between groups comparisons (Independent Student's t-tests) and correlations (Pearson correlation) were performed (α= 0.05). Stroke subjects showed poorer STS performance, greater values of maximum forward flexion at fast speeds, and a lower peak flexor momentum at both speeds (0.001≤p≤0.022). In general, the correlations were significant, moderate (0.001≤p≤0.028), and positive to maximum forward flexion (0.37≤r≤0.54) and negative to peak flexor momentum (-0.58≤r≤-0.71). The poorer STS performance in stroke survivors is associated to the kinematic changes of the trunk related to the poorer ability to generate/transfer the trunk flexor momentum.

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors.

Purpose. The aim of this present study was to investigate the ground reaction forces (GRFs) alterations in stroke survivors with diabetic peripheral neuropathy (DPN). Methods. Ten stroke survivors with DPN, 10 stroke survivors without DPN, and 10 healthy controls with matched body weight between groups participated in this case-control cross-sectional study. Three-dimensional GRFs (anterior-posterior, medial-lateral, and vertical) were collected at a comfortable walking speed using the Nexus Vicon motion analysis system and force plate. The Kruskal–Wallis test was used to analyze GRFs parameters. Results. We found significant alterations of medial-lateral forces of the nonparetic side and vertical forces of the paretic side in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. In addition, there were smaller braking and lower propulsion peak in anterior-posterior forces, smaller magnitude of medial-lateral forces, and lower first and second peak of vertical forces in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. Conclusion. The study findings identified that GRFs were affected in stroke survivors with DPN on both the paretic and the nonparetic sides. Further investigations are warranted to explore the impact of DPN on the kinematics and muscle activity related to the gait performance in stroke survivors with DPN.

A novel computational model to probe visual search deficits during motor performance.

Visual search has traditionally been studied in cognitive and perceptual paradigms, but little is known about how it contributes to visuomotor performance. We have developed a novel computational model to examine how three underlying processes of visual search (spatial planning, working memory, and peripheral visual processing) contribute to visual search during a visuomotor task. We show that deficits integrating spatial planning and working memory underlie abnormal performance in stroke survivors with frontoparietal damage.

Robotic Assessment Modules for Upper Limb Stroke Assessment: Preliminary Study

Conventional assessment scales are widely used to quantify motor performance in stroke survivors. Although they are widely used, there are several limitations with these assessment scales such as lack of repeatability, subjective, time-consuming and it depends on the ability of the trained physiotherapist. In contrast, robot-based assessments are highly repeatable, objective, and could potentially reduce assessment time. However, robotbased assessments are not as well established as conventional assessment scale and the correlation to conventional assessment scale is unclear. This study was to determine if there are any similarities in the movements between the proposed robotic assessment modules namely as Draw Square, Draw Diamond and Draw Circle and between the sequences, clockwise and counter clockwise on 10 male healthy subjects. Result shows that there are no similarities between each robotic assessment modules and between the sequences. All kinematic variables extracted from each robotic assessment modules can be used as benchmark for assessment purpose in stroke patient.