Rehabilitation Progress Research Articles

Improving motor function after chronic stroke by interactive gaming with a redesigned MR-compatible hand training device.

New rehabilitation strategies enabled by technological developments are challenging the prevailing concept of there being a limited window for functional recovery after stroke. In this study, we examined the utility of a robot-assisted therapy used in combination with a serious game as a rehabilitation and motor assessment tool in patients with chronic stroke. We evaluated 928 game rounds from 386 training sessions of 8 patients who had suffered an ischemic stroke affecting middle cerebral artery territory that incurred at least 6 months prior. Motor function was assessed with clinical motor scales, including the Fugl-Meyer upper extremity (FM UE) scale, Action Research Arm Test, Modified Ashworth scale and the Box and Blocks test. Robotic device output measures (mean force, force-position correlation) and serious game score elements (collisions, rewards and total score) were calculated. A total of 2 patients exhibited a marginal improvement after a 10-week training protocol according to the FM UE scale and an additional patient exhibited a significant improvement according to Box and Blocks test. Motor scales showed strong associations of robotic device parameters and game metrics with clinical motor scale scores, with the strongest correlations observed for the mean force (0.677<Ρ<0.869), followed by the number of collisions (-0.670<Ρ<-0.585). Linear regression analysis showed that these indices were independent predictors of motor scale scores. In conclusion, a robotic device linked to a serious game can be used by patients with chronic stroke and induce at least some clinical improvements in motor performance. Robotic device output parameters and game score elements associate strongly with clinical motor scales and have the potential to be used as predictors in models of rehabilitation progress.

Speech–language therapists’ perceptions of an eLearning program to support training in videofluoroscopic swallow studies

Speech-language therapists (SLTs) seek a range of educational opportunities for training in adult videofluoroscopic swallow studies (VFSS). However, variable training methods and/or unequal access to training can influence VFSS practice. To document current SLT needs and barriers to VFSS training and to determine if a new beginner-level VFSS eLearning program would assist to meet their training needs. The program incorporated multimedia modules on preparing, conducting, interpreting and reporting VFSS. SLTs with limited experience in adult VFSS completed surveys relating to VFSS training experience and barriers, and perceived changes in knowledge, skills and confidence on core VFSS module topics pre- (n = 36) and post- (n = 32) eLearning training. Inconsistent access to VFSS training opportunities and time-related work pressures were reported as the greatest training barriers. SLTs viewed the eLearning program as a suitable option for VFSS training. Post-training, participants perceived they gained confidence, as well as improved knowledge and skills in all VFSS aspects along with generalised benefits for dysphagia management. SLTs indicated that key benefits of the eLearning program were its comprehensive content and self-directed learning with multimedia tools, which afforded theoretical and practical learning opportunities. The eLearning program offered SLTs free access to beginner-level adult VFSS training, meeting many identified training needs and providing a foundation from which to develop further practical knowledge and skills within a VFSS clinic setting. What this paper adds What is already known on the subject SLTs demonstrate variable knowledge and skill in conducting and interpreting VFSS, which can impact dysphagia diagnosis and management. While access to VFSS training can be challenging, the barriers to training for SLTs have not been clearly documented. Research has confirmed that eLearning can be used effectively in healthcare education, and in some aspects of VFSS training; however, it is yet to be applied to address the broad range of VFSS training needs. What this paper adds to existing knowledge This study describes the SLT reported barriers to VFSS training which include limited access to formal and practical training, workload-related time pressures and the complexity of learning the VFSS skill set. The findings highlight that an eLearning program, was an accepted mode of learning for VFSS training. SLTs reported the online program met their learning needs by improving access to training, the multimedia program features supported their understanding of complex anatomical and physiological concepts, and training frameworks assisted their clinical reasoning and VFSS interpretation. What are the potential or actual clinical implications of this work? eLearning can assist in overcoming many VFSS training barriers identified by SLTs and the multimedia aspects of eLearning can effectively support VFSS beginner-level education to complement and expedite in-clinic practical training. Given that VFSS results inform decisions regarding commencement and progression of oral intake and swallow rehabilitation, enhanced VFSS training has the potential to positively influence dysphagia outcomes and quality of life.

Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation

ObjectiveTo describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DesignRetrospective, longitudinal cohort study. SettingInpatient rehabilitation unit of an urban academic medical center. ParticipantsAmong 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. InterventionNone. Main Outcome MeasuresChanges in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as “improved,” “unchanged,” or “declined” between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). ResultsFor the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. ConclusionsDespite group gains from DC to 6M and an apparent “plateau” after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.

Evaluation of Knee Kinematics and Moments during Active Deep Flexion Activity after Oxford Mobile-Bearing Medial UKA-A Two-Year Follow-Up Study.

Few studies have assessed knee range of motion (ROM) and moments of patients with mobile-bearing unicompartmental knee arthroplasty (MB UKA) during active deep flexion activities. We analyze knee kinematic and kinetic parameters during postoperative squatting-standing activity, aiming to evaluate the efficacy of MB UKA and postoperative rehabilitation progress. This was a clinical cohort study. We followed up with 37 patients diagnosed with medial knee osteoarthritis (OA) with primary UKA. After screening 31 patients were recruited to take gait tests. Squatting-standing activities were performed under the test of 10-camera motion analysis system and force plates preoperatively at different stages after UKA (12, 18, and 24 months). The average duration of follow-up was 24.4 months (from 22.8 to 26.7 months). Hip-knee-ankle angle improved significantly compared with pre-UKA as well as scores of American Knee Society Score, numeric rating scale, ORS, and Western Ontario and McMasters. University Osteoarthritis Index. About 83.6% (31/37) of follow-up patients completed squatting-standing activity independently. At 1-year follow-up, peak varus angle (20.6 ± 2.8 degrees), internal rotation angle (13.6 ± 1.8 degrees), extensor moment (1.44 ± 0.04N*m/kg), and internal rotator moment (0.02 ± 0.005N*m/kg) of UKA knees were inferior to contralateral knees. Peak adductor moment (0.76 ± 0.05N*m/kg) was superior to contralateral knees. At 2-year follow-up, peak flexion angle (125.0 ± 2.8 degrees) showed a growing trend meanwhile extensor (1.70 ± 0.03N*m/kg) and adductor (0.68 ± 0.06 N*m/kg) moment closely resembled those of the contralateral knee. MB UKA could alleviate the affected knee mainly in flexion-extension ROM and moment meanwhile did not affect the biomechanical indicators of healthy limbs. OA knees in the early postoperative period showed decreased extensor moment and increased adductor moment during active deep flexion activity. Better ROM and relatively more natural extensor and adductor moment of UKA knee with rehabilitation time increasing may predict ideal rehabilitation outcome in the medium or longer term.

Rehabilitation progress after lower-extremity bypass surgery in patients with peripheral arterial disease with different occlusive lesions.

[Purpose] To examine the differences in rehabilitation progress after lower-extremity bypass surgery for peripheral arterial disease (PAD) depending on the occlusive lesions. [Participants and Methods] This was a retrospective study. We included 50 patients (61 limbs; 38 males and 12 females; mean age, 73 years) who underwent lower-extremity bypass surgery for Fontaine stage 2–3 PAD. The patients were assigned to the aortoiliac (A-I) group (n=23), femoropopliteal (F-P) group (n=18), and below-knee group (n=9). We evaluated the postoperative rehabilitation progress and length of hospital stay of these groups. [Results] The postoperative ankle-brachial pressure index (ABI) of the A-I group was significantly lower than that of the F-P group, although there were no differences before surgery. The progress of rehabilitation and the length of hospitalization showed no significant differences among the three groups. The postoperative date of independent walking was significantly later in the presence of complications than in the absence of complications. [Conclusion] The progress of rehabilitation after lower-extremity bypass surgery did not differ depending on the occlusive lesions, and patients may acquire independent walking ability in approximately 5 days in the absence of postoperative complications.

Impact of sarcopenia on the progress of cardiac rehabilitation and discharge destination after cardiovascular surgery.

[Purpose] To investigate the factors that affect the progress of cardiac rehabilitation, length of stay in the hospital, and discharge destination after cardiovascular surgery. [Participants and Methods] This was a prospective observational study. Sixty-seven patients scheduled to undergo open-heart surgery were included in the study. We evaluated physical and psychiatric functions pre- and post-surgery. Sarcopenia was defined as a short physical performance battery score of <9.5. [Results] Sarcopenia was a significant factor of delay of the day of the first rehabilitation, independence in 100-m walking, and exercise training at the rehabilitation gym. Comparisons between pre- and post-surgery were performed in the sarcopenia group. No significant decreases in physical and psychiatric functions were found. The discharge transfer rate was significantly different between the sarcopenia and non-sarcopenia groups. Sarcopenia and the decline in balance score significantly correlated with discharge transfer. [Conclusion] Cardiac rehabilitation can achieve recovery of physical and psychiatric functions even in patients with sarcopenia; however, the discharge transfer rate among the patients with sarcopenia was high. Improving balance ability may result in early home discharge.

Quadriceps strength to body weight ratio is a significant indicator for initiating jogging after anterior cruciate ligament reconstruction

BackgroundQuadriceps strength recovery after anterior cruciate ligament (ACL) reconstruction is an important criterion for progress in rehabilitation and return to sports. The purpose of this study was to determine whether quadriceps strength to body weight ratio (QS/BW) is a significant indicator for initiating jogging after ACL reconstruction. MethodsIsokinetic quadriceps strength at 60°/s was measured and a jogging trial was completed 3 months after ACL reconstruction with hamstring tendon autograft in 83 patients (36 male, 47 female; mean age, 26.6 ± 12.4 years). Based on the jogging trial results, patients were assigned to either a successful jogging group (mean velocity ≥ 9 km/h) or an unsuccessful jogging group (mean velocity < 9 km/h). The association between QS/BW and successful jogging after surgery was investigated by multivariate logistic regression analysis and the cut-off value was determined by receiver operating characteristic analysis. ResultsForty-four patients (53.0%) were assigned to the successful jogging group and 39 (47.0%) to the unsuccessful jogging group. QS/BW was independently associated with initiating jogging 3 months after surgery. The cut-off value of QS/BW for successful jogging was 1.45 Nm/kg (area under the curve = 0.94; sensitivity = 88.6%, specificity = 87.2%). All of the patients who initiated jogging with QS/BW of > 1.45 Nm/kg at 3 months returned to sports without recurrence or contralateral injury by 10 months after surgery. ConclusionsQS/BW is a significant indicator for safely initiating jogging 3 months after ACL reconstruction. The cut-off value of QS/BW for initiating jogging was 1.45 Nm/kg.

Reliability of Clinical Rating Scale in Evaluation of Head Control in children with Cerebral Palsy

Introduction The clinical rating scale for head control assesses control of head/neck in children with neurological conditions. Head control is important for activities of daily living and quality of life in children. Objectives The aim of the study was to determine the intra-rater and inter-rater reliability of the scale in children with Cerebral Palsy. Method The study was a cross-sectional study approved by Research ethics committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital involving children with CP. Three independent raters assessed the children using Clinical Rating Scale for Head Control at two different times, and the intra-rater and inter-rater reliabilities were analyzed using kappa statistics and Bland-Altman analysis. Results Fifty children with CP with mean age, 24.17±12.17 months participated in the study. The result of the study showed that there were very good agreement in all the test positions for the three raters and between the first and the second ratings and in all the test positions between the three raters respectively (k&gt;0.8). Similarly, there was no proportional bias between ratings in 24 of the measurements (p&gt;0.05). Conclusion Clinical rating scale for head control seems to be a reliable instrument. Thus, it can be used to monitor the progress of rehabilitation in CP patients to help improve their quality of life.

Reliability of Peg Restrained Intrinsic Muscle Evaluator for Measurement of Intrinsic Hand Muscle Strength in Adults with Tetraplegia

Background: The manual muscle test (MMT) is the traditional method to assess the intrinsic hand muscle test. However, this test is qualitative and subjective. A device capable of rapidly measuring motor output along a linear scale may be of value in the evaluation of hand recovery from any neurological impairment. Objective: To demonstrate inter-rater reliability of the Peg Restrained Intrinsic Muscle Evaluator (PRIME) device for measuring intrinsic hand muscle strength in adults with impaired hand functions. Methods: 16 subjects (2 female, 14 male, mean age=47±15 years) with cervical spinal cord injury were enrolled. Intrinsic hand muscle strength of adults were performed by two-tester with use of PRIME device and manual muscle testing, within the same session. Inter-tester correlation was tested by Pearson's correlation and Intraclass correlation coefficient (ICC). Results: Intraclass correlation coefficients for hypothenar, first dorsal interosseous, abductor pollicis brevis and opponence pollicis muscles ranged from 0.7 to 0.8 with hypothenar muscle test being lowest ICC=0.7 and thumb opposition highest, ICC=0.81. Conclusion: Results from this study suggest that PRIME device demonstrates good reliability within testers for quantified measuring of intrinsic hand muscle strength. Further use of PRIME in clinic will aid in diagnostics, medical decision making and evaluation of rehabilitation progress in patients with cervical spinal cord injury.

Vibration Stimulation as a Non-Invasive Approach to Monitor the Severity of Meniscus Tears.

Musculoskeletal disorders and injuries are one of the most prevalent medical conditions across age groups. Due to a high load-bearing function, the knee is particularly susceptible to injuries such as meniscus tears. Imaging techniques are commonly used to assess meniscus injuries, though this approach suffers from limitations including high cost, need for skilled personnel, and confinement to laboratory or clinical settings. Vibration-based structural monitoring methods in the form of acoustic emission analysis and vibration stimulation have the potential to address the limits associated with current diagnostic technologies. In this study, an active vibration measurement technique is employed to investigate the presence and severity of meniscus tear in cadaver limbs. In a highly controlled ex vivo experimental design, a series of cadaver knees (n =6) were evaluated under an external vibration, and the frequency response of the joint was analyzed to differentiate the intact and affected samples. Four stages of knee integrity were considered: baseline, sham surgery, meniscus tear, and meniscectomy. Analyzing the frequency response of injured legs showed significant changes compared to the baseline and sham stages at selected frequency bandwidths. Furthermore, a qualitative analytical model of the knee was developed based on the Euler-Bernoulli beam theory representing the meniscus tear as a change in the local stiffness of the system. Similar trends in frequency response modulation were observed in the experimental results and analytical model. These findings serve as a foundation for further development of wearable devices for detection and grading of meniscus tear and for improving our understanding of the physiological effects of injuries on the vibration characteristics of the knee. Such systems can also aid in quantifying rehabilitation progress following reconstructive surgery and / or during physical therapy.

Secreted Peptides for Diagnostic Trajectory Assessments in Brain Injury Rehabilitation

Background Rehabilitation following traumatic brain injury (TBI) significantly improves outcomes; yet TBI heterogeneity raises the need for molecular evidence of brain recovery processes to better track patient progress, evaluate therapeutic efficacy, and provide prognostication. Objective Here, we assessed whether the trajectory of TBI-responsive peptides secreted into urine can produce a predictive model of functional recovery during TBI rehabilitation. Methods The multivariate urinary peptidome of 12 individuals with TBI was examined using quantitative peptidomics. Measures were assessed upon admission and discharge from inpatient rehabilitation. A combination of Pavlidis template matching and partial least-squares discriminant analysis was used to build models on Disability Rating Scale (DRS) and Functional Independence Measure (FIM) scores, with participants bifurcated into more or less functional improvement groups. Results The produced models exhibited high sensitivity and specificity with the area under the receiver operator curve being 0.99 for DRS- and 0.95 for FIM-based models using the top 20 discriminant peptides. Predictive ability for each model was assessed using robust leave-one-out cross-validation with Q2 statistics of 0.64 (P = .00012) and 0.62 (P = .011) for DRS- and FIM-based models, respectively, both with a high predictive accuracy of 0.875. Identified peptides that discriminated improved functional recovery reflected heightened neuroplasticity and synaptic refinement and diminished cell death and neuroinflammation, consistent with postacute TBI pathobiology. Conclusions Produced models of urine-based peptide measures reflective of ongoing recovery pathobiology can inform on rehabilitation progress after TBI, warranting further study to assess refined stratification across a larger population and efficacy in assessing therapeutic interventions.

Wearable triboelectric nanogenerator based exercise system for upper limb rehabilitation post neurological injuries

Recent rehabilitation methods for physical impairments utilize various technologies such as robotic devices and gaming software in order to assist, motivate, and facilitate the recovery process. While most of the rehabilitation devices require external power sources, the triboelectric nanogenerator (TENG) has been proven as a reliable self-powered sensor that can also be used as an energy harvester. In this work, we utilize the TENG as a game controller as well as an exercise device for patients undergoing rehabilitation. We show that since the TENG can store energy, it serves as a motivating factor for the patient, as well as an index to monitor progression of rehabilitation and any improvements they make during rehabilitation. First, we describe the working principle of the TENG-based rehabilitation device (Rehab-TENG) and perform parametric studies to determine the performance of the device. Second, we developed a circuit to digitize the TENG output so that the patient could use the Rehab-TENG to control a computer game via Bluetooth. Third, the Rehab-TENG was employed as an energy harvester in an exercise system, where the patient moved their impaired arm to store energy into a capacitor. Based on the speed of capacitor charging, the level of impairment could be estimated. Finally, the patients were asked to answer a questionnaire where they emphasized the practicability of the device for its use as a home-based rehabilitation system and the harvesting of energy as a motivating factor for them to move their impaired body part more than they normally would. We expect this study will enhance the potential of TENG use in healthcare as a practical tool for patient rehabilitation.

Development of Stand-walking Simulator for Rehabilitation Training

A rehabilitation equipment is developed by mechanical and electronic engineering principle based on the need of rehabilitation training for patients with paraplegia. The device can prevent complications such as palsy bedsores and deep venous thrombosis. The device effectively reduces the labor intensity of the rehabilitation staff or family members to carry the patient's body, and promotes the physical and psychological rehabilitation progress of patients with lower limb paralysis.

Characterizing gait pattern dynamics during symmetric and asymmetric walking using autoregressive modeling.

Gait asymmetry is often observed in populations with varying degrees of neuromuscular control. While changes in vertical ground reaction force (vGRF) peak magnitude are associated with altered limb loading that can be observed during asymmetric gait, the challenge is identifying techniques with the sensitivity to detect these altered movement patterns. Autoregressive (AR) modeling has successfully delineated between healthy and pathological gait during running; but has been little explored in walking. Thus, AR modeling was implemented to assess differences in vGRF pattern dynamics during symmetric and asymmetric walking. We hypothesized that the AR model coefficients would better detect differences amongst the symmetric and asymmetric walking conditions than the vGRF peak magnitude mean. Seventeen healthy individuals performed a protocol that involved walking on a split-belt instrumented treadmill at different symmetric (0.75m/s, 1.0 m/s, 1.5 m/s) and asymmetric (Side 1: 0.75m/s-Side 2:1.0 m/s; Side 1:1.0m/s-Side 2:1.5 m/s) gait conditions. Vertical ground reaction force peaks extracted during the weight-acceptance and propulsive phase of each step were used to construct a vGRF peak time series. Then, a second order AR model was fit to the vGRF peak waveform data to determine the AR model coefficients. The resulting AR coefficients were plotted on a stationarity triangle and their distance from the triangle centroid was computed. Significant differences in vGRF patterns were detected amongst the symmetric and asymmetric conditions using the AR modeling coefficients (p = 0.01); however, no differences were found when comparing vGRF peak magnitude means. These findings suggest that AR modeling has the sensitivity to identify differences in gait asymmetry that could aid in monitoring rehabilitation progression.

Prevalence of spatial neglect post-stroke: A systematic review.

Spatial neglect (SN) impedes stroke rehabilitation progress, slows functional recovery, and increases caregiver stress and burden. The estimation of SN prevalence varies widely across studies. We aimed to establish the prevalence of SN based on the injured cerebral hemisphere, recovery stage post-stroke, and diagnostic methodology. All journal articles published up to February 27, 2019 from CINAHL, PsycINFO, PubMed and Web of Science were searched. We selected original research articles that described observational studies, included both individuals with left brain damage (LBD) and those with right brain damage (RBD) post-stroke, and reported specific diagnostic methods for SN. All authors reached consensus for the final selection of 41 articles. Time post-stroke, patient selection criteria, study setting, SN diagnostic methods were extracted. A total of 6324 participants were included: 3411 (54%) with RBD and 2913 (46%) with LBD. Without considering time post-stroke or diagnostic methods, the occurrence rate of SN was 29% (38% after RBD and 18% after LBD). Using ecological assessments resulted in higher prevalence than using tests not directly related to daily life activities (53% vs. 24%). Using methods based on a single-cutoff criterion led to lower occurrence of SN than using multi-test methods (27% vs. 33%). The prevalence decreased from the acute to chronic stage post-stroke. The estimated prevalence of SN after unilateral stroke is 30%. SN is more common after RBD than after LBD, but SN after LBD is still quite common. Using ecological assessments and multi-test methods to detect SN is preferred to using a single-cutoff criterion of a test that is not directly related to daily function. The decrease in SN prevalence over time is evident, but the exact prevalence in later stages cannot be estimated. More research is needed to better understand chronic SN.

How to assess visual function in acquired brain injury-Asking is not enough.

BackgroundAcquired brain injury affects many brain areas and causes a range of dysfunctions including vision‐related issues. These issues can have negative impacts on rehabilitation progress and activities of daily life but may easily be overlooked. There is no common recommendation about how to assess visual impairments after ABI. The purpose of this study was to estimate the frequency of objectively measures oculomotor dysfunctions, and also how these findings are related to two inventories intended to support detection of visual impairment.MethodsThe study was cross‐sectional and included 73 outpatients. In addition to the standard evaluation program, the patients went through a comprehensive optometric examination. The inventories used were the Vision Interview (VI) and the Convergence Insufficiency Symptom Survey (CISS).ResultsAll three types of examinations showed a high proportion vision‐related symptoms. Fusion vergence was the most common objectively measured finding, 83%. There were seven statistically significant associations between five VI items and five visual deficits. The strength of associations was moderate (Phi 0.261–0.487, p < .05). The sensitivity and specificity of the CISS were moderate.ConclusionWe found high percentages of the patients with visual symptoms and dysfunctions. Due to the complexity of visual symptoms and functional deficits in ABI, we find it necessary to combine both symptom assessment and vision examination in order to capture visual function issues.

Functional assessment of the gluteus medius, cranial part of the biceps femoris, and vastus lateralis in Beagle dogs based on a novel gait phase classification.

In humans, walking analysis based on the gait phase classification has been used for interpretation of functional roles of different movements occurring at individual joints, and it is useful for establishing a rehabilitation plan. However, there have been few reports on canine gait phase classification, and this is one of the reasons for preventing progress in canine rehabilitation. In this study, we determined phases of the canine gait cycle (GC) on the basis of the phase classification for human gait. The canine GC was able to be divided into initial contact (IC) and the following 5 phases: loading response (LR), middle stance (MidSt), pre-swing (PSw), early swing (ESw), and late swing (LSw). Next, the hind limb joint angles of the hip, stifle and tarsal joints and results of surface electromyography of the gluteus medius (GM), cranial part of the biceps femoris (CBF) and vastus lateralis (VL) muscles in relation to the gait phases were analyzed. The activities of three muscles showed similar changes during walking. The muscle activities were high in the LR phase and then declined and reached a minimum in the PSw phase, but they increased and reached a peak in the LSw phase, which was followed by the LR phase. In conclusion, the multiphasic canine GC was developed by modification of the human model, and the GC phase-related changes in the muscle activity and joint angles suggested the functions of GM, CBF and VL muscles in walking.

Evaluating Rehabilitation Progress Using Motion Features Identified by Machine Learning.

Evaluating progress throughout a patient's rehabilitation episode is critical for determining the effectiveness of the selected treatments and is an essential ingredient in personalised and evidence-based rehabilitation practice. The evaluation process is complex due to the inherently large human variations in motor recovery and the limitations of commonly used clinical measurement tools. Information recorded during a robot-assisted rehabilitation process can provide an effective means to continuously quantitatively assess movement performance and rehabilitation progress. However, selecting appropriate motion features for rehabilitation evaluation has always been challenging. This paper exploits unsupervised feature learning techniques to reduce the complexity of building the evaluation model of patients' progress. A new feature learning technique is developed to select the most significant features from a large amount of kinematic features measured from robotics, providing clinically useful information to health practitioners with reduction of modeling complexity. A novel indicator that uses monotonicity and trendability is proposed to evaluate kinematic features. The data used to develop the feature selection technique consist of kinematic data from robot-aided rehabilitation for a population of stroke patients. The selected kinematic features allow for human variations across a population of patients as well as over the sequence of rehabilitation sessions. The study is based on data records pertaining to 41 stroke patients using three different robot assisted exercises for upper limb rehabilitation. Consistent with the literature, the results indicate that features based on movement smoothness are the best measures among 17 kinematic features suitable to evaluate rehabilitation progress.

Progression of Strength, Flexibility, and Palpation Pain During Rehabilitation of Athletes With Acute Adductor Injuries: A Prospective Cohort Study.

To investigate the relationship between repeated clinical measures and the progression of rehabilitation of male athletes with acute adductor injuries. Prospective observational cohort study. Male athletes with acute adductor injuries received a standardized criteria-based rehabilitation program with 4 repeated clinical measures during rehabilitation: the extent of palpation pain (length and width in centimeters), the bent-knee fall-out test (BKFO; in centimeters), hip abduction range of motion (in degrees), and eccentric hip adduction strength (in Newton meters per kilogram). We analyzed the association between each clinical measure and the percent progression of rehabilitation until return to sport (RTS), divided into 2 RTS milestones: (1) clinically pain free, and (2) completion of controlled sports training. The analyses included 61 male athletes for RTS milestone 1 and 50 athletes for RTS milestone 2, and 381 to 675 tests were performed for each clinical measure. The median time to RTS milestones 1 and 2 was 15 days (interquartile range, 12-29 days) and 24 days (interquartile range, 16-34 days), respectively. Each repeated clinical measure individually explained 13% to 36% of the variance in rehabilitation progression to the RTS milestones. The extent of palpation pain explained the highest variance of the progression of rehabilitation (R2 = 0.26-0.27 for length and R2 = 0.36 for width, P<.001). Eccentric adduction strength (R2 = 0.19-0.27, P<.001) improved throughout rehabilitation, whereas the flexibility tests (BKFO, R2 = 0.13-0.15; P<.001 and hip abduction range of motion, R2 = 0.19-0.21; P<.001) returned to normal values early in rehabilitation. Repeated measures of adductor strength, flexibility, and palpation pain provided only a rough impression of rehabilitation progress following acute adductor injuries in male athletes. These clinical measures cannot define a precise recovery point during rehabilitation. J Orthop Sports Phys Ther 2021;51(3):126-134. Epub 28 Oct 2020. doi:10.2519/jospt.2021.9951.

Comorbidities in Males and Females with TBI: A Population Study from the Department of Social Inclusion of Persons with Disabilities in Cyprus

Comorbidities are common in individuals with traumatic brain injury (TBI) because they can influence the progression and outcomes of rehabilitation. Furthermore, investigating sex differences in this area will provide great understanding in how comorbid disorders can influence rehabilitation contribute to the development of person-centered rehabilitation programs. The main purpose of this study was to investigate specific comorbid disorders in males and females survivors of TBI. This is population study as all individuals with a reported diagnosis of TBI who applied for disability benefits were include in the analyses.