Post-stroke Hemiparesis Research Articles

Efficacy of Current Methods for Correction of Talipes Equinovarus in Patients with Central Hemiparesis

Abstract The problem of physiological gait stereotype restoration in patients with post-stroke central hemiparesis remains relevant to this day. This is primarily associated with high risk of falls in this category of patients. At this point, there is a wide variety of methods related to exercise treatment and robotised correction or restoration of impaired gait against the background of post-stroke hemiparesis. At the same time, the problem of management of talipes equinovarus associated with this syndrome remains quite complex and not completely solved. We have analysed existing methods of talipes equinovarus correction with different levels of evidentiality.

Characterizing intersection variability of butterfly diagram in post-stroke gait using Kernel Density Estimation

BackgroundCenter of pressure (COP) trajectory during treadmill walking have been commonly presented using the butterfly diagram to describe gait characteristics in neurologically intact and impaired individuals. However, due to the large amount of displayed information, the butterfly diagram is not an efficient solution to visualize locomotor variability. PurposeThe purpose of this study was to evaluate post-stroke locomotor variability by applying Kernel density estimation (KDE) on the intersections of the butterfly diagram, and to compare KDE derived metrics with conventional metrics of gait symmetry and variability. MethodsBilateral toe-off (TO) and initial contact (IC) points of the butterfly diagram were determined to calculate the COP symmetry index and the intersections of bilateral TOIC. Subsequently, the intersections during the walking window were used to evaluate its density and variability by Kernel density estimation. Standard deviations of step width and step length were compared between groups. ResultsUsing the KDE surface plots we observed 4 characteristically different patterns with individuals post-stroke, which were associated with functional status quantified using walking speed and lower extremity Fugl-Meyer scores. However, locomotor variability quantified using standard deviations of step width and lengths did not differ between groups.Significance & Novelty: This paper presents a novel approach of using KDE analysis as a better and more sensitive method to characterize locomotor COP variability in individuals with post-stroke hemiparesis, compared to conventional metrics of gait symmetry and variability.

Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial

ABSTRACTBackground: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 – 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 – 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.

Reliability of upright weight-bearing distribution measures obtained by computed baropodometry for participants with and without post-stroke hemiparesis

Background/Aims Measurements from force platforms and digital scales have been applied to classify weight-bearing distribution in post-stroke hemiparesis. However, an intermediate tool – computed baropodometry – is breaking new ground in this field of diagnosis, with a need to report its reliability. Intra-test and test/retest reliabilities of the percentage of total body weight borne by the predominantly used hemibody calculated from computed baropodometry in participants with and without chronic hemiparesis was investigated in this study. Methods A total of 40 participants were evaluated and combined for age and sex in two different groups. Repeated measures were taken to analyse differences among records obtained from averages during 5, 10 or 20 seconds (intra-test reliability) and between the test and 1-week retest (test/retest reliability) for both groups. The analysis of variance, intra-class correlation coefficient and data plotted by Bland-Altman method were administrated. Results The intra-test analysis did not show differences among records obtained from different time durations (5, 10 and 20 seconds). Excellent to moderate intra-class correlation coefficient values (0.794 to 0.644) between test and retest were observed in the hemiparesis group from the records obtained by short to the longer lasting time durations, while for control groups, intra-class correlation coefficient values (0.661 to 0.748) were classified as moderate. Conclusions Acceptable reliability was found for all participants. Moreover, improved repeatability was reported when the measures were obtained by shorter time periods for both groups.

Use of Pelvic Corrective Force With Visual Feedback Improves Paretic Leg Muscle Activities and Gait Performance After Stroke.

The purpose of this study was to examine the effects of combined pelvic corrective force and visual feedback during treadmill walking on paretic leg muscle activity and gait characteristics in individuals with post-stroke hemiparesis. Fifteen chronic stroke participants completed visual feedback only and combined pelvic corrective force and visual feedback conditions during treadmill walking. Each condition included: 1-minute baseline, 7-minute training with visual feedback only or additional pelvic corrective force, 1-minute post training, 1-minute standing break, and another 5-minute training. EMGs from the paretic leg muscles and step length were measured. Overground walking was evaluated before treadmill walking, immediately and 10 minutes after treadmill walking. Greater increases in integrated EMG of all muscles, except vastus medialis and tibialis anterior, were observed with the application of additional pelvic corrective force compared to visual feedback only during treadmill walking. Overground walking speed significantly increased after treadmill training with combined pelvic correction force and visual feedback, but was not significant for the visual feedback only condition. Voluntary weight shifting with additional pelvic corrective force enhanced paretic leg muscle activities and improved gait characteristics during walking. Individuals with post-stroke hemiparesis could adapt feedforward control and generalize the adaptation to overground walking.

Mirror feedback assisted recovery from hemiparesis following stroke. In Reply to Morkisch et al.: How to perform mirror therapy after stroke? Evidence from a meta-analysis

1 out of 6 people worldwide will have suffered a stroke in their lifetime, 1/3rd of whom will die. Of the 2/3rd who survive, half will be permanently disabled (World Stroke Organization). Given these alarming statistics, it's not surprising that tremendous of amounts of time, resources and funding have been devoted towards research into stroke rehab. In view of this, simple, easy-to-implement procedures are highly sought after. One such procedure is the use of visual feedback conveyed by a mirror, which seems to reactivate some dormant pathways in patients who have suffered a recent stroke (Altschuler etal., 1999; Ramachandran & Altschuler, 2009). This procedure has been validated in several dozen clinical trials, of which a substantial number were conducted rigorously. Morkisch etal. (2019) now present a systematic review and meta-analysis of this dense literature pertaining to this topic. They conclude that "there is a high level evidence for mirror therapy's effectiveness in treating post-stroke hemiparesis". A novel conclusion that emerged from this meta-analysis was that the larger the mirror the more effective the treatment is. Additionally, if an object is manipulated by the normal hand and its reflection viewed in the mirror, the procedure is not as effective, possibly because the discrepancy of signals between the visual feedback (reflection of the object) and the lack of confirmatory somatosensory input from the affected limb leads to inhibition rather than synergy. Lastly, for reasons yet unclear, sending movement commands to the unaffected hand alone (unilateral) is more effective than sending bilateral commands, contrary to the original protocol.Taken collectively, research in this field has two implications - First, the immediate practical utility in the clinic by optimizing mirror therapy's efficacy for hemiparesis after stroke. Second, it leads to a rejection of the model of the brain as made up of isolated, autonomous modules, towards a more dynamic picture, in which the brain is composed of a fluctuating mosaic of neural activity as it adapts to changing sensory inputs. Therefore, dysfunction results not from 'punch out a module - lose a function', but by shifts in equilibria, which can be corrected, perhaps, by hitting a reset button. Even if this turns out to be true for a minority of syndromes, it will be well worth the effort.

Standing postural stability during galvanic vestibular stimulation is associated with the motor function of the hemiplegic lower extremity post-stroke

ABSTRACTBackground: The vestibular system is profoundly involved in standing postural stability. Patients with post-stroke hemiparesis have poor postural control function; nevertheless, it is unclear as to how the vestibular system affects postural control after stroke.Objectives: The purpose of this study was to quantitatively evaluate the relationship between galvanic whole-body sway responses and motor function of the hemiplegic lower extremity post-stroke.Methods: Thirty stroke patients and 49 healthy controls underwent standing body sway tests to examine postural control function during vestibular stimulation. Postural stabilization was measured using a C7-mounted accelerometer during galvanic vestibular stimulation. Postural stability was assessed during stimulation while quietly standing with eyes closed. For the stroke group, lower extremity function was measured using the Fugl-Meyer Assessment scale (FMA-LE).Results: The standing body sway test scores during stimulation were lower in the stroke group than the control group (p = .010). In the stroke group, correlation analysis demonstrated that the standing body sway response score was significantly associated with the FMA-LE (r = 0.374, p = .021).Conclusions: Motor dysfunction directly causes standing postural instability during vestibular stimulation, even though sensory information suggests normal peripheral vestibular function. Therefore, motor dysfunction of the hemiplegic lower extremity might lead to inhibition of normal standing postural stability.

Impaired H-Reflex Adaptations Following Slope Walking in Individuals With Post-stroke Hemiparesis.

Background and Purpose Short term adaptations in the Ia afferent-motoneuron pathway, as measured using the H-reflex, in response to altered ground reaction forces (GRFs) applied at the feet during slope walking have been observed in the non-impaired nervous system. The ability of the stroke-impaired nervous system to adapt to altered GRFs have not been examined. The purpose of this study was to examine the acute effects of altered propulsive and braking forces applied at the feet, which naturally occurs when walking on different slopes, on adaptations of the H-reflex pathway in individuals with chronic post-stroke hemiparesis.MethodsTwelve individuals chronically post-stroke and 10 age-similar non-neurologically impaired controls walked on an instrumented treadmill for 20 min under level, upslope and downslope conditions. GRFs were measured during walking and soleus H-reflexes were recorded prior to and immediately after walking. A 3 (limbs: paretic, non-paretic, and non-impaired) × 3 (slope: level, upslope, downslope) mixed factorial ANOVA was conducted on the propulsive and braking forces. A 2 (limb: paretic and non-impaired) × 2 (time: pre and post) × 3 (slope: level, upslope, and downslope) mixed factorial ANOVA was conducted to assess the soleus H-reflex amplitudes.ResultsIn both post-stroke and non-impaired groups, during downslope walking, peak propulsive forces decreased, while peak braking forces increased. In contrast, during upslope walking, peak propulsive forces increased and peak braking forces decreased. We observed reduced soleus H-reflex amplitudes immediately following 20 min of level, downslope and upslope walking in non-impaired individuals but not in the paretic legs of individuals with chronic post-stroke hemiparesis.Discussion and ConclusionSimilar pattern of change in peak propulsive and braking forces with respect to different slopes was observed in both individuals post-stroke and non-impaired individuals, but the magnitude of GRFs were smaller in individuals post-stroke due to the slower walking speed. Our results suggested that impaired modulation of the H-reflex pathway potentially underlies the lack of neuroadaptations in individuals with chronic post-stroke hemiparesis.

Poststroke Postural Sway Improved by Botulinum Toxin: A Multicenter Randomized Double-blind Controlled Trial

ObjectiveTo assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. DesignA multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. SettingClinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. ParticipantsPeople with hemiparesis with chronic post stroke lower limb spasticity (N=40). InterventionsIntramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. Main Outcome MeasuresThe sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. ResultsForty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (−0.7, P=.049 in the soleus muscles; −0.8, P=.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P=.005) in the sway area occurred in the treatment group (−3.11±6.92) in comparison with the placebo group (+0.27±3.57). ConclusionTreating spasticity by injecting botulinum toxin into people’s lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose.

Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial

BackgroundRecovery of upper limb function in individuals after a stroke remains challenging. Modified constraint-induced movement therapy (m-CIMT) has strong evidence for increasing the use and recovery of sensorimotor function of the paretic upper limb. Recent studies have shown that priming with aerobic exercise prior to task-specific training potentiates upper limb recovery in individuals with stroke. This protocol describes a randomized clinical trial designed to determine whether priming with moderate-high intensity aerobic exercise prior to m-CIMT will improve the manual dexterity of the paretic upper limb in individuals with chronic hemiparesis.MethodsSixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + m-CIMT or Stretching + m-CIMT. m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence. Aerobic exercise will be conducted on a stationary bicycle at intervals of moderate to high intensity. Participants will be evaluated at baseline, 3, 30, and 90 days postintervention by the following instruments: Motor Activity Log, Nottingham Sensory Assessment, Wolf Motor Function Test, Box and Block Test, Nine-Hole Peg Test, Stroke Specific Quality of Life Scale and three-dimensional kinematics. The data will be tested for normality and homogeneity. Parametric data will be analyzed by two-way ANOVA with repeated measures and Bonferroni’s adjustment. For nonparametric data, the Friedman test followed by the Wilcoxon test with Bonferroni’s adjustment will be used to compare the ratings for each group. To compare the groups in each assessment, the Mann-Whitney test will be used.DiscussionThis study will provide valuable information about the effect of motor priming for fine upper limb skill improvement in people with chronic poststroke hemiparesis, bringing new evidence about the association of two therapies commonly used in clinical practice.Trial registrationThis trial was retrospectively registered (registration number RBR-83pwm3) on 07 May 2018.

Lower extremity long-latency reflexes differentiate walking function after stroke.

The neural mechanisms of walking impairment after stroke are not well characterized. Specifically, there is a need for understanding the mechanisms of impaired plantarflexor power generation in late stance. Here, we investigated the association between two neurophysiologic markers, the long-latency reflex (LLR) response and dynamic facilitation of antagonist motor-evoked responses, and walking function. Fourteen individuals with chronic post-stroke hemiparesis and thirteen healthy controls performed both isometric and dynamic plantarflexion. Transcranial magnetic stimulation (TMS) assessed supraspinal drive to the tibialis anterior. LLR activity was assessed during dynamic voluntary plantarflexion and individuals post-stroke were classified as either LLR present (LLR+) or absent (LLR-). All healthy controls and nine individuals post-stroke exhibited LLRs, while five did not. LLR+ individuals revealed higher clinical scores, walking speeds, and greater ankle plantarflexor power during walking compared to LLR- individuals. LLR- individuals exhibited exaggerated responses to TMS during dynamic plantarflexion relative to healthy controls. The LLR- subset revealed dysfunctional modulation of stretch responses and antagonist supraspinal drive relative to healthy controls and the higher functioning LLR+ individuals post-stroke. These abnormal physiologic responses allow for characterization of individuals post-stroke along a dimension that is clinically relevant and provides additional information beyond standard behavioral assessments. These findings provide an opportunity to distinguish among the heterogeneity of lower extremity motor impairments present following stroke by associating them with responses at the nervous system level.

The Effect of a Low-Cost Body Weight-Supported Treadmill Trainer on Walking Speed and Joint Motion.

Background and Objectives: Gait training with body weight-support has been shown to improve the walking speed of individuals with movement disorders. The AccesSportAmerica Gait Trainer is a low-cost, pre-market gait rehabilitation device that alters the stride characteristics of participants walking on a standard treadmill. The purpose of this study was to examine the biomechanical outcomes that training on this device has for people with brain injuries that affect motor functioning. It was hypothesized that there would be an increase in walking speed post-intervention, and that there would be an increase in step length and joint range-of-motion. Materials and Methods: An intervention study was conducted with 11 people with ambulatory difficulty caused by post-stroke hemiparesis (n = 7), traumatic brain injury (n = 3), and cerebral palsy (n = 1). The average time using the AccesSportAmerica Gait Trainer was 34.5 (SD = 6.0) minutes per session for 36.9 (SD = 21.8) sessions. Gait speed, step length and time, and joint flexion were measured during the 10 Meter Walk Test. Results: From pre- to post-intervention, there was a mean increase in walking speed of 0.19 m/s (SD = 0.06, p = 0.016, d = 0.40) and a decrease in step time of both affected and unaffected legs (affected: p = 0.011, d = 0.37; unaffected: p = 0.004, d = 0.67). There was no significant change in stride length or joint angles. Conclusions: The AccesSportAmerica Gait Trainer has the potential to improve the walking speed of people with ambulatory difficulty.

The kinematics of paretic lower limb in aquatic gait with equipment in people with post-stroke hemiparesis

BackgroundDevices are commonly used in aquatic gait rehabilitation; therefore, investigating the effect of these devices is important. We evaluated the combined use of buoyancy cuffs and ankle weights during aquatic gait on paretic leg kinematics in people with hemiparesis. MethodsFifteen adults (58.6 ± 4.8 years) in the chronic phase post-stroke walked on a 4.5 m walkway with underwater immersion at the height of the xiphoid process in five conditions: (1) without equipment; (2) with ankle weights or (3) buoyancy cuffs on both legs; (4) with a buoyancy leg cuff on the non-paretic leg and an ankle weight on the paretic leg; (5) with an ankle weight on the non-paretic leg and a buoyancy leg cuff on the paretic leg. Five trials were performed for each condition for a total of 25 trials and the kinematic data were recorded. Analysis of covariance was used with walking velocity as a covariate to analyze spatiotemporal and angular variables of the paretic leg. FindingsThe condition with buoyancy cuff on the paretic leg increased (~20°) the maximum angle of knee flexion in the mid-swing phase compared to that seen with weights on both legs or weight on the paretic leg. Buoyancy cuffs on the paretic leg increased the step length by 5.6 cm. The ankle weights on the paretic leg condition increased the total (6%) and single support (4%) duration compared to that seen with a buoyancy cuff on the paretic leg. InterpretationAquatic gait with buoyancy cuffs on both legs or on the paretic leg can modify gait kinematics compared to that with weight on both legs or on the paretic leg. Long term effects of training with those conditions needs further research.

Interpreting Prefrontal Recruitment During Walking After Stroke: Influence of Individual Differences in Mobility and Cognitive Function.

Background: Functional near-infrared spectroscopy (fNIRS) is a valuable neuroimaging approach for studying cortical contributions to walking function. Recruitment of prefrontal cortex during walking has been a particular area of focus in the literature. The present study investigated whether task-related change in prefrontal recruitment measured by fNIRS is affected by individual differences in people post-stroke. The primary hypotheses were that poor mobility function would contribute to prefrontal over-recruitment during typical walking, and that poor cognitive function would contribute to a ceiling in prefrontal recruitment during dual-task walking (i.e., walking with a cognitive task).Methods: Thirty-three adults with chronic post-stroke hemiparesis performed three tasks: typical walking at preferred speed (Walk), serial-7 subtraction (Serial7), and walking combined with serial-7 subtraction (Dual-Task). Prefrontal recruitment was measured with fNIRS and quantified as the change in oxygenated hemoglobin concentration (ΔO2Hb) between resting and active periods for each task. Spatiotemporal gait parameters were measured on an electronic walkway. Stepwise regression was used to assess how prefrontal recruitment was affected by individual differences including age, sex, stroke region, injured hemisphere, stroke chronicity, 10-meter walking speed, balance confidence measured by Activities-specific Balance Confidence (ABC) Scale, sensorimotor impairment measured by Fugl-Meyer Assessment, and cognitive function measured by Mini-Mental State Examination (MMSE).Results: For Walk, poor balance confidence (ABC Scale score) significantly predicted greater prefrontal recruitment (ΔO2Hb; R2 = 0.25, p = 0.003). For Dual-Task, poor cognitive function (MMSE score) significantly predicted lower prefrontal recruitment (ΔO2Hb; R2 = 0.25, p = 0.002).Conclusions: Poor mobility function predicted higher prefrontal recruitment during typical walking, consistent with compensatory over-recruitment. Poor cognitive function predicted lower prefrontal recruitment during dual-task walking, consistent with a recruitment ceiling effect. These findings indicate that interpretation of prefrontal recruitment should carefully consider the characteristics of the person and demands of the task.

Tasked-Based Functional Brain Connectivity in Multisensory Control of Wrist Movement After Stroke.

In this study we documented brain connectivity associated with multisensory integration during wrist control in healthy young adults, aged matched controls and stroke survivors. A novel functional MRI task paradigm involving wrist movement was developed to gain insight into the effects of multimodal sensory feedback on brain functional networks in stroke participants. This paradigm consisted of an intermittent position search task using the wrist during fMRI signal acquisition with visual and auditory feedback of proximity to a target position. We enrolled 12 young adults, 10 participants with chronic post-stroke hemiparesis, and nine age-matched controls. Activation maps were obtained, and functional connectivity networks were calculated using an independent component analysis (ICA) approach. Task-based networks were identified using activation maps, and nodes were obtained from the ICA components. These nodes were subsequently used for connectivity analyses. Stroke participants demonstrated significantly greater contralesional activation than controls during the visual feedback condition and less ipsilesional activity than controls during the auditory feedback condition. The sensorimotor component obtained from the ICA differed between rest and task for control and stroke participants: task-related lateralization to the contralateral cortex was observed in controls, but not in stroke participants. Connectivity analyses between the lesioned sensorimotor cortex and the contralesional cerebellum demonstrated decreased functional connectivity in stroke participants (p < 0.005), which was positively correlated the Box and Blocks arm function test (r2 = 0.59). These results suggest that task-based functional connectivity provides detail on changes in brain networks in stroke survivors. The data also highlight the importance of cerebellar connections for recovery of arm function after stroke.

An open-label randomized pragmatic non-inferiority pilot trial comparing the effectiveness of Curare 30CH against individualized homeopathic medicines in post-stroke hemiparesis

BackgroundPost-stroke hemiparesis is the most common complication following stroke. Due to unsatisfactory results from conventional treatment, alternative treatments including homeopathy are increasingly becoming popular. Curare is the one of the recommended homeopathic medicine prescribed on ‘common symptoms’ of motor paralysis, but has not been researched systematically. We hypothesized that Curare 30CH would be non-inferior to individualized homeopathy (IH) in treatment of post-stroke hemiparesis in the context of standard physiotherapy. MethodsAn open, randomized (1:1), exploratory, two parallel arms, pragmatic, non-inferiority, pilot trial was conducted at the Homoeopathic Materia Medica out-patient departments of National Institute of Homoeopathy (NIH), India on 50 patients comparing the effectiveness of Curare 30CH against IH. Comparative analysis was carried out on the primary outcome to detect non-inferiority by one-tailed t test at alpha = 5% with a prefixed margin (Δ) of 1.0 based on assumption. Oxford muscle strength grading scale and stroke impact scale (SIS) questionnaires were the primary and secondary outcomes respectively; assessed at baseline, after 3 and 6 months of treatment. ResultsFive subjects dropped out (Curare: 3, IH: 2). Groups were comparable at baseline (all P > 0.01). In both groups, both the outcomes improved significantly after 3 and 6 months. Non-inferiority was demonstrated by Curare 30CH against IH, both over 3 months (mean difference = 0.04, lower 95% confidence limit −0.195, t = 7.429, P < 0.001) and 6 months (mean difference = −0.2, lower 95% confidence limit −0.474, t = 4.899, P < 0.001). No adverse events were reported from either group. ConclusionBoth therapies seemed to produce comparable effects, and appeared as safe, still, being a pilot trial, no definite conclusion could be drawn. Further exploration of both efficacy and effectiveness of either of the therapies is necessary by adequately powered trials and independent replications.

Studying the correlation between balance assessment by Biodex Stability System and Berg Scale in stroke individuals

IntroductionBalance disorders are considered to be a serious clinical manifestation after stroke. Therefore, to assess stroke patients' balance performance, use of a quantitative method appears essential. A fundamental step would be the approval of the efficiency of the measurement instruments. The current study aimed to investigate correlations between balance assessment as examined by Biodex Stability System (BSS) and the clinical Berg Balance Scale (BBS) in post-stroke hemiparesis. MethodsTwenty-five stroke survivors and 25 healthy age-sex matched subjects were recruited. The subjects were assessed using BSS during 3 days, with a 24-h interval. The high interclass correlation coefficient (ICC) values showed that the system was reliable enough to continue the study. The clinical evaluation was performed by the standard BBS. ResultsThere was a significant moderate negative correlation between the Biodex overall indices and BBS scores in the stroke groups (ravg = −0.68) and in the healthy cohort (ravg = -0.55). Also, a significant moderate negative correlation was found between the Biodex antero-posterior stability indices and BBS scores in the stroke groups (ravg = −0.67) and in healthy cohort (ravg = −0.55). The correlation between the Biodex mediolateral stability indices and BBS scores was moderate to low in the stroke and healthy groups (ravg = −0.67 and −0.39 respectively). Discussion and conclusionModerate negative correlation between the stability indices of the Biodex Stability System and BBS scores indicates that dynamic balance status of the participants partially reflects their functional balance status.

Retraction: The gait deviation index is differently affected in children with cerebral palsy hemiparesis and adults with post-stroke hemiparesis

This article refers to:RETRACTED ARTICLE: The gait deviation index is differently affected in children with cerebral palsy hemiparesis and adults with post-stroke hemiparesis

RETRACTED ARTICLE: The gait deviation index is differently affected in children with cerebral palsy hemiparesis and adults with post-stroke hemiparesis

View retraction statement:Retraction: The gait deviation index is differently affected in children with cerebral palsy hemiparesis and adults with post-stroke hemiparesis

(Re)defining breast cancer survivorship as embodied space of “we”: How complementary and alternative medicine providers promote body acceptance

Post-stroke hemiparesis is the most common complication following stroke. Due to unsatisfactory results from conventional treatment, alternative treatments including homeopathy are increasingly becoming popular. Curare is the one of the recommended homeopathic medicine prescribed on ‘common symptoms’ of motor paralysis, but has not been researched systematically. We hypothesized that Curare 30CH would be non-inferior to individualized homeopathy (IH) in treatment of post-stroke hemiparesis in the context of standard physiotherapy.An open, randomized (1:1), exploratory, two parallel arms, pragmatic, non-inferiority, pilot trial was conducted at the Homoeopathic Materia Medica out-patient departments of National Institute of Homoeopathy (NIH), India on 50 patients comparing the effectiveness of Curare 30CH against IH. Comparative analysis was carried out on the primary outcome to detect non-inferiority by one-tailed t test at alpha = 5% with a prefixed margin (Δ) of 1.0 based on assumption. Oxford muscle strength grading scale and stroke impact scale (SIS) questionnaires were the primary and secondary outcomes respectively; assessed at baseline, after 3 and 6 months of treatment.Five subjects dropped out (Curare: 3, IH: 2). Groups were comparable at baseline (all P > 0.01). In both groups, both the outcomes improved significantly after 3 and 6 months. Non-inferiority was demonstrated by Curare 30CH against IH, both over 3 months (mean difference = 0.04, lower 95% confidence limit −0.195, t = 7.429, P < 0.001) and 6 months (mean difference = −0.2, lower 95% confidence limit −0.474, t = 4.899, P < 0.001). No adverse events were reported from either group.Both therapies seemed to produce comparable effects, and appeared as safe, still, being a pilot trial, no definite conclusion could be drawn. Further exploration of both efficacy and effectiveness of either of the therapies is necessary by adequately powered trials and independent replications.