Task-oriented treadmill training with versus without posterior elastic resistance in chronic stroke survivors with limited walking function: a randomised controlled trial with exploratory strength-GRF-speed associations

 With NO protocol created and NO objective starting point this research is nonrepeatable, totally fucking useless!

Task-oriented treadmill training with versus without posterior elastic resistance in chronic stroke survivors with limited walking function: a randomised controlled trial with exploratory strength-GRF-speed associations

• Fang-Yu Cheng,
• Yan-Ting Chen,
• Sang-I Lin,
• Hui-Yu Tseng &
• Pei-Yun Lee 

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Abstract

Background

Reduced gait speed, impaired ground reaction force (GRF) generation, and lower-limb weakness are common in chronic stroke survivors and contribute to limited functional mobility. Although treadmill training can improve walking capacity, it remains unclear whether adding posterior elastic resistance provides incremental benefits in propulsion-related kinetics and in the functional linkage among strength, GRF, and walking performance, particularly in individuals with limited walking function. This study compared intensity-matched task-oriented treadmill training with versus without posterior resistance and secondarily explored changes in strength-GRF-speed relationships.

Methods

Forty chronic stroke participants were randomly assigned to conventional treadmill training (CON) or treadmill training with posterior resistance (EXP). Both groups received training for 30 min/session, twice weekly for eight weeks. Primary outcomes included preferred and maximum gait speed, bilateral vertical and anterior-posterior GRFs during walking, and lower-limb muscle strength. Secondary outcomes included walking energy expenditure (V̇O₂). Multivariate repeated-measures ANOVA was used to assess training effects. Pre-post associations among gait speed, GRFs, and strength were evaluated as secondary exploratory analyses.

Results

In the primary unadjusted analyses, both groups demonstrated significant time effects for preferred and maximum gait speed, walking energy expenditure, and affected-side knee flexor, knee extensor, and ankle plantarflexor strength (all p < 0.05). However, sensitivity analyses adjusted for stroke onset duration showed that several time effects were attenuated. A significant between-group difference was observed only for the second vertical GRF peak on the affected side at maximum speed, which was higher in EXP than CON and remained significant after adjustment (p = 0.049). No broad group × time interaction effects were observed. Exploratory analyses showed that post-training associations among gait speed, affected-side strength, and anterior-posterior GRF appeared more consistent.

Conclusions

In chronic stroke survivors with limited walking function, intensity-matched treadmill-based gait training improved walking speed, oxygen uptake, and lower-limb strength, although several time effects were attenuated after adjusting for stroke onset duration. Adding posterior resistance showed a condition-specific between-group difference in paretic late-stance vertical loading at maximum speed but did not result in broad superiority in functional outcomes. Posterior elastic resistance may serve as a feasible adjunct to augment paretic-limb loading during high-demand walking.

Trial registration ClinicalTrials.gov Protocol Registration: trial number NCT04974840

Upper limb recovery in early acute phase stroke survivors by coupled EMG-triggered and cyclic neuromuscular electrical stimulation

More non objective research starting points. Severe has no objective meaning. Don't give me the excuse it is using the Rankin scale, that is not objective at all except for #6, death.

Upper limb recovery in early acute phase stroke survivors by coupled EMG-triggered and cyclic neuromuscular electricalstimulation

NeuroRehabilitation , Volume 46(3) , Pgs. 417-422.

NARIC Accession Number: J83974.  What's this?
ISSN: 1053-8135.
Author(s): Obayashi, Shigeru ; Takahashi, Rina ; Onuki, Mitsugu.
Publication Year: 2020.
Number of Pages: 6.
Abstract: Study investigated the effects of coupled electromyography (EMG)-triggered and cyclic neuromuscular electrical stimulation (NMES) on upper-extremity (UE) paresis during the early acute phase of stroke. Seventeen participants with severe UE disability completed the study. Eight subjects in the intervention group received 15 to 20 minutes of NMES prior to 20 minutes of standard care per day, 5 times per week. Nine age- and severity-matched subjects received a two consecutive 20-minute sessions of standard care per day, 5 times per week. Outcome measures included the UE motor section of the Fugl-Meyer Motor Assessment Scale (FMA-UE), the Wolf motor function test (WMFT), and the Box and Block Test (BBT). The NMES group received treatment (average session: 10.87) after a median 7 days from stroke (16.5 sessions after 5 days for controls). To adjust the different treatment durations, "progress rate" was defined as the gains of UE function scores divided by treatment duration. The progress rate was significantly different in FMA-UE, but not in WMFT and BBT. The results indicate the beneficial effect of coupled EMG-triggered and cyclic NMES for UE paresis during early acute phase of stroke.
Descriptor Terms: ACUTE CARE, ELECTRICAL STIMULATION, ELECTROPHYSIOLOGY, LIMBS, MOTOR SKILLS, PHYSICAL THERAPY, REHABILITATION SERVICES, SERVICE DELIVERY, STROKE.


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Citation: Obayashi, Shigeru , Takahashi, Rina , Onuki, Mitsugu. (2020). Upper limb recovery in early acute phase stroke survivors by coupled EMG-triggered and cyclic neuromuscular electrical stimulation.  NeuroRehabilitation , 46(3), Pgs. 417-422. Retrieved 7/18/2020, from REHABDATA database.

Contralesional Hemisphere Control of the Proximal Paretic Upper Limb following Stroke

Since there is no objective definition of mild, moderate or severely impaired this is actually totally useless. With no objective starting point this research is not repeatable in any way.

Contralesional Hemisphere Control of the Proximal Paretic Upper Limb following Stroke

2012, Cerebral Cortex
 Lynley V. Bradnam 1,2, 

Cathy M. Stinear 2,3, 

P. Alan Barber 2,3

and Winston D. Byblow 1,2

1 Movement Neuroscience Laboratory, Department of Sport & Exercise Science, and
2 Centre for Brain Research and
3 Neurology Research Group, Department of Medicine, The University of Auckland, Auckland, New Zealand 1142.
 Address correspondence to Winston D. Byblow, Movement Neuroscience Laboratory, Department of Sport & Exercise Science, The University of  Auckland, Auckland, New Zealand 1142. Email: w.byblow@auckland.ac.nz.
Cathodal transcranial direct current stimulation (c-tDCS) can reduce excitability of neurons in primary motor cortex (M1) and may facilitate motor recovery after stroke. However, little is known about the neurophysiological effects of tDCS on proximal upper limb function. We hypothesized that suppression of contralesionalM1 (cM1) excitability would produce neurophysiological effects that depended on the severity of upper limb impairment. Twelve patients with varying upper limb impairment after subcortical stroke were assessed on clinical scales of upper limb spasticity, impairment, and function. Magnetic resonance imaging was used to determine lesion size and fractional anisotropy (FA) within the posterior limbs of the internal capsules indicative of corticospinaltract integrity. Excitability within paretic M1 biceps brachii representation was determined from motor-evoked potentials during selective isometric tasks, after cM1 sham stimulation and after c-tDCS. These neurophysiological data indicate that c-tDCS improved selective proximal upper limb control for mildly impaired patients and worsened it for moderate to severely impaired patients. The direction of the neurophysiological after effects of c-tDCS was strongly related to upper limb spasticity, impairment,function, and FA asymmetry between the posterior limbs of the internal capsules. These results indicate systematic variation ofcM1 for proximal upper limb control after stroke and that suppression of cM1 excitability is not a ‘‘one size fits all’’ approach.Keywords:
 corticospinal tract, ipsilateral pathways, magnetic resonance imaging, stroke prediction, transcranial direct current stimulation
Introduction
Six months after stroke, up to two-thirds of patients are unable to incorporate a weak hand into activities of daily living(Dobkin 2005). Following stroke there is often an imbalance in primary motor cortex (M1) excitability, with relative under-excitability in the stroke affected ipsilesional hemisphere and relative over excitability in the contralesional hemisphere, and worse outcomes for patients with greater imbalance ( Traversa et al. 1998). Rebalancing of cortical excitability in patients withstroke has been associated with improvement of upper limb function ( Traversa et al
.
 1998; Shimizu et al. 2002; Murase et al.2004; Stinear et al. 2008; Swayne et al. 2008) and can be promoted with noninvasive brain stimulation (Hummel andCohen 2006). Transcranial direct current stimulation (tDCS) isa form of noninvasive brain stimulation that suppresses or facilitates M1 depending on the electrode polarity (Nitsche and Paulus 2000, 2001; Nitsche et al. 2003; Nitsche et al. 2005). Cathodal tDCS (c-tDCS) hyperpolarizes neurons and can beused to reduce the relative overexcitability of the contralesional hemisphere (Nowak et al. 2009).Proximal upper limb muscles are innervated by projections from contralateral and ipsilateral motor cortex, and this bilateral pattern of organization has functional implications for adjuvants such as tDCS (Kuypers and Brinkman 1970; Turton et al. 1996; Lemon 2008). There is recent evidence in healthy adults that suppression of M1 can influence control of the ipsilateral proximal upper limb by reducing or increasing excitability of ipsilateral descending projections from non-invasive brain stimulation (Bradnam, Stinear, and Byblow 2010;McCambridge et al. 2011). However, upregulation of ipsilateral projections from contralesional M1 (cM1) may be an important functional adaptation in patients severely affected by stroke( Ward et al. 2006; Ward et al. 2007). Therefore, contralesional c-tDCS might not benefit this subgroup of patients. This might explain why cM1 suppression has had mixed effects on measures of paretic upper limb function in stroke patients to date. While some studies have shown positive effects on upperlimb function (Fregni et al. 2005; Boggio et al. 2007; Grefkes et al. 2010; Kim et al. 2010), others have reported deleterious(Johansen-Berg et al. 2002; Murase et al. 2004; Lotze et al. 2006; Ackerley et al. 2010; Bestmann et al. 2010) or no effects (Talelliet al. 2007). These mixed findings indicate it is unlikely that there will be a ‘‘one size fits all’’ strategy for promoting upper limb function after stroke with noninvasive brain stimulation and that the extent to which the cM1 contributes to control of the paretic upper limb needs to be taken into account when selecting protocols for an individual patient. Therefore, the efficacy of contralesional c-tDCS may depend on whether patients are mildly or severely impaired (Schlaug et al. 2008). This study examined the effects of c-tDCS of cM1 on paretic proximal upper limb muscle activation in patients withsubcortical stroke. We hypothesized that because contralesional c-tDCS may suppress ipsilateral descending projections to proximal upper limb, after effects would depend on the relative contribution of cM1 to control of paretic proximal muscles. We predicted that for mildly impaired patients cM1might interfere with control from the ipsilesional M1 at thelevel of the spinal cord. Therefore, suppressive tDCS of cM1 was expected to improve the control of the paretic proximal upper limb. Conversely, we predicted that for moderate to severely impaired patients control would be degraded because suppressing cM1 would down regulate ipsilateral compensatory  pathways for proximal paretic upper limb control for these patients.

Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Post stroke: A Randomized Controlled Study

Can't tell from the abstract if this was done during spontaneous recovery and can't see any objective measurement of starting points. With no starting point this research is not repeatable.  'May' just means followup needed which will never occur under current non-existent leadership. 

Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Post  stroke: A Randomized Controlled Study

 Ming Wu, PhD,
a,b
Jill M. Landry, MSPT,
a
Janis Kim, MPT,
a
Brian D. Schmit, PhD,
a,b,c
Sheng-Che Yen, PT, PhD,
a
Jillian MacDonald, DPT
a
From the Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL;
 b
Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL; and
 c
Department of Biomedical Engineering, Marquette University, Milwaukee, WI. Current affiliation for Yen, Department of Physical Therapy, Northeastern University, Boston, MA.

Abstract

Objective:

 To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals post stroke.
Design:
 Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.
Setting:
 Research units of rehabilitation hospitals.
Participants:
 Patients (N=30) with chronic stroke.
Intervention:
 Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking. For the assistance group, a load that assists swing was applied.
Main Outcome Measures:
 Primary outcome measures were walking speed and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and quality of life. Outcome measures were evaluated before and after 6 weeks of training and at 8 weeks’ follow-up, and compared within group and between the 2 groups.
Results:
 After 6 weeks of robotic training, walking speed significantly increased for both groups, with no significant differences in walking speed gains observed between the 2 groups. In addition, 6-minute walking distance and balance significantly improved for the assistance group but not for the resistance group.
Conclusions:
 Applying a controlled resistance or an assistance load to the paretic leg during treadmill training may(NOT good enough, we need certainty) induce improvements in walking speed in individuals post stroke. Resistance training was not superior to assistance training in improving locomotor function in individuals post stroke. 

Detection of body postures and movements in ambulatory adults with cerebral palsy: a novel and valid measure of physical behaviour

If your doctor and therapists are not doing any objective mapping of your movement disabilities they can't make any of their interventions repeatable because they don't know the starting point. So call the president and ask when competent people will be employed at the rehab place. 

Detection of body postures and movements in ambulatory adults with cerebral palsy: a novel and valid measure of physical behaviour

• Everett A. Claridge,
• Rita J. G. van den Berg-Emons,
• Herwin L. D. Horemans,
• Wilma M. A. van der Slot,
• Nick van der Stam,
• Ada Tang,
• Brian W. Timmons,
• Jan Willem Gorter &
• Johannes B. J. Bussmann 

Journal of NeuroEngineering and Rehabilitation volume 16, Article number: 125 (2019) Cite this article

Abstract

Background

Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and clinically applicable activity monitor (AM, Activ8), in the detection of body postures and movements in adults with spastic cerebral palsy (CP); and 2) to evaluate the extent that the AM’s positioning affects validity.

Methods

In this cross-sectional study, 14 ambulatory adults with CP [9 men; mean (SD) age, 35.4 (13.1) years] performed standardized activities while wearing three Activ8 monitors - frontolateral thigh (primary position), frontal thigh, and pant pocket - and being video recorded (criterion measure). AM activity output was compared to synchronized video recordings. Absolute (seconds) and relative [(video time–AM time)/mean time, %] time differences between methods were calculated. Relative time differences of < 10% were indicative of good validity. Comparison of AM attachment positions was completed using Spearman Rho correlation coefficients and Meng’s tests.

Results

Criterion validity of the AM (frontolateral thigh) was good (average relative time differences: 0.25% for sitting, 4.69% for standing, 2.46% for walking, 1.96% for upright activity, 3.19% for cycling), except for running (34.6%). Spearman Rho correlation coefficients were greater between video/frontolateral thigh position than video/frontal thigh position and video/pant pocket position for body posture and movement categories sitting, standing, walking, and upright activity (p < 0.01 for all).

Conclusions

The AM, positioned on the frontolateral thigh, demonstrated good criterion validity in ambulatory adults with CP. Though the Activ8 offers potential as an objective measure of physical activity, appropriate positioning is paramount for valid measurement.

Training and orthotic effects related to functional electrical stimulation of the peroneal nerve in stroke

I see no written protocol, so useless for other survivors. With no objective starting point none of this is repeatable. 

 

Training and orthotic effects related to functional electrical stimulation of the peroneal nerve in stroke

Journal of Rehabilitation Medicine (formerly the Scandinavian Journal of Rehabilitation Medicine) , Volume 49(2) , Pgs. 113-119.

NARIC Accession Number: J81387.  What's this?
ISSN: 1650-1977.
Author(s): Street, Tamsyn; Swain, Ian; Taylor, Paul.
Publication Year: 2017.
Number of Pages: 7.
Abstract: Study examined the evidence for a training effect of functional electrical stimulation (FES) on the lower limb in 104 patients more than six month post stroke. An “orthotic effect” describes the immediate improvement in walking observed with FES compared with that without FES. A “training or therapeutic effect” describes a long-term improvement in walking without the FES after using FES for several weeks. Training and orthotic effects were determined from walking speed over 10 meters, associated minimal (>0.05 meters per second [m/s]) and substantial (>0.10 m/s) clinically important differences, and Functional Ambulation Category (FAC), ranging from household walking to independent walking in the community. An overall significant training effect was found that was not a clinically important difference (0.02 m/s); however, "community" FAC (≥ 0.8 m/s) and "most limited community walkers" FAC (0.4-0.58 m/s), but not "household walkers" (< 0.4 m/s), benefitted from a clinically important difference. A highly significant, substantial clinically important orthotic effect (0.10 m/s) was found. In terms of overall improvement of one or more FACs, 23 percent achieved this due to a training effect, compared with 43 percent due to an orthotic effect. The findings suggest that FES provides a training effect in those who are less impaired. Further work, which optimizes the use of the device for restoration of function, rather than as an orthotic device, will provide greater clarity on the effectiveness of FES for eliciting a training effect.
Descriptor Terms: AMBULATION, ELECTRICAL STIMULATION, MOBILITY IMPAIRMENTS, NERVES, OUTCOMES, STROKE, THERAPEUTIC TRAINING.


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Citation: Street, Tamsyn, Swain, Ian, Taylor, Paul. (2017). Training and orthotic effects related to functional electrical stimulation of the peroneal nerve in stroke.  Journal of Rehabilitation Medicine (formerly the Scandinavian Journal of Rehabilitation Medicine) , 49(2), Pgs. 113-119. Retrieved 8/20/2019, from REHABDATA database.