Craniectomy and Cranioplasty Effects on Balance and Gait in Rehabilitation: A Retrospective Study.

Objective: To analyze changes in balance and gait in patients undergoing rehabilitation postcraniectomy and postcranioplasty, including comparison of outcomes across time periods, rate of change, and among diagnoses.

Design: Retrospective cohort study.

Setting: Inpatient rehabilitation.

Amplify Gait to Improve Locomotor Engagement in Spinal Cord Injury (AGILE SCI) trial: study protocol for an assessor blinded randomized controlled trial.

Background: Among ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.

Reliability and Validity of the Functional Gait Assessment in Incomplete Spinal Cord Injury.

Background: There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI).

Objectives: To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI.

Methods: Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C ( = 2) or D ( = 10), were included.

Effect of sensory feedback from the proximal upper limb on voluntary isometric finger flexion and extension in hemiparetic stroke subjects.

This study investigated the potential influence of proximal sensory feedback on voluntary distal motor activity in the paretic upper limb of hemiparetic stroke survivors and the potential effect of voluntary distal motor activity on proximal muscle activity. Ten stroke subjects and 10 neurologically intact control subjects performed maximum voluntary isometric flexion and extension, respectively, at the metacarpophalangeal (MCP) joints of the fingers in two static arm postures and under three conditions of electrical stimulation of the arm. The tasks were quantified in terms of maximum MCP torque [MCP flexion (MCP(flex)) or MCP extension (MCP(ext))] and activity of targeted (flexor digitorum superficialis or extensor digitorum communis) and nontargeted upper limb muscles.

Prolonged electrical stimulation over hip flexors increases locomotor output in human SCI.

Objectives: The objective of this study was to determine whether enhanced feedback from thigh afferents improves locomotor output in human spinal cord injury (SCI).

Methods: The effects of afferent feedback originating from the upper thigh muscles on locomotion was examined using electrical stimulation in 10 subjects with incomplete SCI and three neurologically intact controls during robotic-assisted treadmill walking. Electrical stimulation consisted of 20 pulses at 30 Hz, applied bilaterally to the skin of the medial thigh, approximately over the sartorius muscle.

Feedback and feedforward locomotor adaptations to ankle-foot load in people with incomplete spinal cord injury.

Humans with spinal cord injury (SCI) modulate locomotor output in response to limb load. Understanding the neural control mechanisms responsible for locomotor adaptation could provide a framework for selecting effective interventions. We quantified feedback and feedforward locomotor adaptations to limb load modulations in people with incomplete SCI.

Daily stepping in individuals with motor incomplete spinal cord injury.

Background: In individuals with motor incomplete spinal cord injury (SCI), ambulatory function determined in the clinical setting is related to specific measures of body structure and function and activity limitations, although few studies have quantified the relationship of these variables with daily stepping (steps/day).

Objective: The aim of this study was to quantify daily stepping in ambulatory individuals with SCI and its relationship with clinical walking performance measures and specific demographics, impairments, and activity limitations.

Design: A cross-sectional study was performed to estimate relationships among clinical variables to daily stepping in self-identified community versus non-community (household) walkers.

Modulation of stretch reflexes of the finger flexors by sensory feedback from the proximal upper limb poststroke.

Neural coupling of proximal and distal upper limb segments may have functional implications in the recovery of hemiparesis after stroke. The goal of the present study was to investigate whether the stretch reflex response magnitude of spastic finger flexor muscles poststroke is influenced by sensory input from the shoulder and the elbow and whether reflex coupling of muscles throughout the upper limb is altered in spastic stroke survivors. Through imposed extension of the metacarpophalangeal (MCP) joints, stretch of the relaxed finger flexors of the four fingers was imposed in 10 relaxed stroke subjects under different conditions of proximal sensory input, namely static arm posture (3 different shoulder/elbow postures) and electrical stimulation (surface stimulation of biceps brachii or triceps brachii, or none).

Rapid and long-term adaptations in gait symmetry following unilateral step training in people with hemiparesis.

Background And Objective: Evidence for specific physical interventions that improve walking symmetry in individuals with hemiparesis poststroke is limited. The aim of this study was to investigate the rapid and prolonged effects of unilateral step training (UST) on step length asymmetry (SLA) in people with hemiparesis.

Subjects And Design: Eighteen individuals with chronic hemiparesis and substantial SLA during overground walking participated in a single-group, pretest-posttest study.

Ankle load modulates hip kinetics and EMG during human locomotion.

The purpose of this research was to examine the role of isolated ankle-foot load in regulating locomotor patterns in humans with and without spinal cord injury (SCI). We used a powered ankle-foot orthosis to unilaterally load the ankle and foot during robotically assisted airstepping. The load perturbation consisted of an applied dorsiflexion torque designed to stimulate physiological load sensors originating from the ankle plantar flexor muscles and pressure receptors on the sole of the foot.

Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke.

Objective: To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke.

Methods: A total of 63 participants<6 months poststroke with an initial walking speed between 0.1 to 0.

Rebound responses to prolonged flexor reflex stimuli in human spinal cord injury.

The purpose of this study was to examine the reflex effects of electrical stimulation applied to the thigh using skin electrodes, targeting the sensory fibers of the rectus femoris and sartorius, in people with spinal cord injury (SCI). Thirteen individuals with SCI were recruited to participate in experiments using prolonged electrical stimuli on the right medial thigh over the regions of the sartorius and rectus femoris muscles. Three stimuli, spaced 20 s apart, were applied at 30 Hz for 1 s at four different intensities (15-60 mA) while subjects rested in a seated position.

Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study.

Background And Purpose: Locomotor training (LT) using a treadmill can improve walking ability over conventional rehabilitation in individuals with hemiparesis, although the personnel requirements often necessary to provide LT may limit its application. Robotic devices that provide consistent symmetrical assistance have been developed to facilitate LT, although their effectiveness in improving locomotor ability has not been well established.

Methods: Forty-eight ambulatory chronic stroke survivors stratified by severity of locomotor deficits completed a randomized controlled study on the effects of robotic- versus therapist-assisted LT.

Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury.

Background And Purpose: Robotic devices that provide passive guidance and stabilization of the legs and trunk during treadmill stepping may increase the delivery of locomotor training to subjects with neurological injury. Lower-extremity guidance also may reduce voluntary muscle activity as compared with compliant assistance provided by therapists. The purpose of this study was to investigate differences in metabolic costs and lower-limb muscle activity patterns during robotic- and therapist-assisted treadmill walking.

Temporal facilitation of spastic stretch reflexes following human spinal cord injury.

Recent evidence suggests that alterations in ionic conductances in spinal motoneurones, specifically the manifestation of persistent inward currents, may be partly responsible for the appearance of hyperexcitable reflexes following spinal cord injury (SCI). We hypothesized that such alterations would manifest as temporal facilitation of stretch reflexes in human SCI. Controlled, triangular wave, ankle joint rotations applied at variable velocities (30-120 deg s(-1)) and intervals between stretches (0.

Flexor reflex responses triggered by imposed knee extension in chronic human spinal cord injury.

Hypersensitivity of the flexor reflex pathways to input from force-sensitive muscle afferents may contribute to the prevalence and severity of muscle spasms in patients with spinal cord injury (SCI). In this study, we triggered flexor reflexes with constant velocity knee movements in 15 subjects with SCI. Ramp and hold knee extension perturbations were imposed on one leg while the hip and ankle were held in an isometric position using an instrumented leg brace.