Effects of locomotor training on the functional recovery from the spinal cord injury

This mini-review surveys several representative rehabilitation studies using a treadmill or other methods of locomotor exercises in humans and experimental animals with spinal cord injury. The methods and effect of locomotor training employed in individual studies are explained and the importance of the sensory input and body weight loading in the stimulation of the central pattern generator is emphasized. The establishment of neural networks by regenerating and/or spared axons is the basis of locomotor improvement. Although regenerating axons are found within the lesion, it is difficult to demonstrate the development of new neural connections. Muscle activity is another important factor in recovery from spinal cord injury. Robotic trainings of rats on a treadmill is not considered suitable for a rehabilitation study, because the robotic movement of the hind limbs differs from natural quadrupedal walking. Clinically, driven gait orthosis is used effectively for locomotor training of patients with SCI

Kinematic and kinetic characteristics of stepping over a 10-cm-high obstacle in older adults

[Purpose] The purpose of this research was to clarify the common responses shared by a high-falldown-risk group of older adults and develop an exercise-learning program to prevent falls. [Subjects] Thirty-four subjects were chosen from those who use the daycare program of a nursing home at least once a week. [Methods] All subjects were categorized in longer or shorter-MSL groups. Ninety-second stepping from two force plates to a 10-cm-high box was executed under three conditions. The locus length of the COP,toe-obstacle distance,and step length were used as experimental data. [Results] The coefficient between the MSL and COP was from 0.69 to 0.73. The shorter-MSL group showed smaller COP movements in the A-P direction and a smaller toe-obstacle distance between the single stepping and stepping with the visual task and between the single stepping and stepping with the auditory task. No significant difference was noted in the step length between the two groups. [Conclusion] The shorter-MSL group was easily affected by the dual-task, suggesting that the shorter-MSL group has a high risk of falling when negotiating obstacles. Stepping exercise with the dual-task using the COP movements as a feedback index may be useful for older adults who have a smaller MSL

The assessments of body sway on the static standing using the center of pressure

The Center of Pressure (COP) has been used in evaluation of balance and motion analysis research. When it is measured with such a platform systems, the COP is defined as the center of the total number of active transducers for each data sample collected. Smaller magnitude of the COP movement on static standing reflects greater ability of postural control. On the contrary, bigger magnitude of the COP movement on static standing reflects poorer ability of postural control. Though this theory has been supported by some researches, there are some exceptions. To clarify the meaning of measuring the COP movements on static standing, we focused on some parameters concerning the COP, reliability and validity of the COP, the way to use, the COP movements of static standing with balance disabled people, the effect of aging on static balance, the relationship between gender and static balance, the effect of a low alcohol dose, and the balance of the day

Goal-orientated cognitive rehabilitation for dementias associated with Parkinson's disease―A pilot randomised controlled trial

OBJECTIVE: To examine the appropriateness and feasibility of cognitive rehabilitation for people with dementias associated with Parkinson's in a pilot randomised controlled study. METHODS: This was a single-blind pilot randomised controlled trial of goal-oriented cognitive rehabilitation for dementias associated with Parkinson's. After goal setting, participants were randomised to cognitive rehabilitation (n = 10), relaxation therapy (n = 10), or treatment-as-usual (n = 9). Primary outcomes were ratings of goal attainment and satisfaction with goal attainment. Secondary outcomes included quality of life, mood, cognition, health status, everyday functioning, and carers' ratings of goal attainment and their own quality of life and stress levels. Assessments were at 2 and 6 months following randomisation. RESULTS: At 2 months, cognitive rehabilitation was superior to treatment-as-usual and relaxation therapy for the primary outcomes of self-rated goal attainment (d = 1.63 and d = 1.82, respectively) and self-rated satisfaction with goal attainment (d = 2.04 and d = 1.84). At 6 months, cognitive rehabilitation remained superior to treatment-as-usual (d = 1.36) and relaxation therapy (d = 1.77) for self-rated goal attainment. Cognitive rehabilitation was superior to treatment as usual and/or relaxation therapy in a number of secondary outcomes at 2 months (mood, self-efficacy, social domain of quality of life, carers' ratings of participants' goal attainment) and at 6 months (delayed recall, health status, quality of life, carer ratings of participants' goal attainment). Carers receiving cognitive rehabilitation reported better quality of life, health status, and lower stress than those allocated to treatment-as-usual. CONCLUSIONS: Cognitive rehabilitation is feasible and potentially effective for dementias associated with Parkinson's disease

Attention control comparisons with SLT for people with aphasia following stroke: methodological concerns raised following a systematic review

Objective: Attention control comparisons in trials of stroke rehabilitation require care to minimize the risk of comparison choice bias. We compared the similarities and differences in SLT and social support control interventions for people with aphasia. Data sources: Trial data from the 2016 Cochrane systematic review of SLT for aphasia after stroke. Methods: Direct and indirect comparisons between SLT, social support and no therapy controls. We double-data extracted intervention details using the template for intervention description and replication. Standardized mean differences and risk ratios (95% confidence intervals (CIs)) were calculated. Results: Seven trials compared SLT with social support (n  =  447). Interventions were matched in format, frequency, intensity, duration and dose. Procedures and materials were often shared across interventions. Social support providers received specialist training and support. Targeted language rehabilitation was only described in therapy interventions. Higher drop-out (P  =  0.005, odds ratio (OR) 0.51, 95% CI 0.32–0.81) and non-adherence to social support interventions (P  <  0.00001, OR 0.18, 95% CI 0.09–0.37) indicated an imbalance in completion rates increasing the risk of control comparison bias. Conclusion: Distinctions between social support and therapy interventions were eroded. Theoretically based language rehabilitation was the remaining difference in therapy interventions. Social support is an important adjunct to formal language rehabilitation. Therapists should continue to enable those close to the person with aphasia to provide tailored communication support, functional language stimulation and opportunities to apply rehabilitation gains. Systematic group differences in completion rates is a design-related risk of bias in outcomes observed

Low dose of Rotigotine in post-stroke patients with vascular parkinsonism and obstructive sleep apnoea syndrome, effects on quality of life and rehabilitation therapy

Stroke is a frequent cause of disability in U.S.A. (200.000/ year). Aim: The aim of this study is to underline the effect of low dose of Rotigotine patches 2 mg/24 h, a complete dopamine agonist with continuous dopaminergic stimulation through the transdermal administration, in elderly with recent stroke and vascular Parkinsonism about quality of life and adherence to rehabilitation therapy. Methods: We have enrolled 6 elderly patients (3 males and 3 females, range age 60 – 95 years) with recent ischemic and vascular Parkinsonism. We have evaluated quality of life and cognitive function with UPDRS part III, MMSE, ADL, IADL and Morinsky Scale. At the same time we have evaluated the adherence to therapy and timing of rehabilitation therapy before and post-administration of Rotigotine 2 mg/24 hours. Conclusion: In conclusion, Rotigotine could be a new useful approach in the treatment of elderly patients with recent ischemic and hemorrhagic stroke correlated with vascular Parkinsonism which can lead to an akinesia with the need to start rehabilitation therapy. Our preliminary data gives comfortable results but, at this time, we have enrolled only few patients to give conclusive results

Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym

Background Stroke rehabilitation in low- and middle-income countries, such as Mexico, is often hampered by lack of clinical resources and funding. To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy, in lower and upper extremities, we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua, Mexico. The Gymnasium for Robotic Rehabilitation (Robot Gym) consisted of low- and high-tech systems for upper and lower limb rehabilitation. Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation, while being more or as effective as traditional physical and occupational therapy approaches. Methods A typical group of stroke patients was randomly allocated to an intervention (n = 10) or a control group (n = 10). The intervention group received rehabilitation using the devices in the Robot Gym, whereas the control group (n = 10) received time-matched standard care. All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks. Several clinical assessments tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention. A cost analysis was done to compare the cost effectiveness for both therapies. Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental, Brunnstrom Test, and Geriatric Depression Scale Test, showing that both groups were functionally similar prior to the intervention. Although, both training groups were functionally equivalent, they had a significant age difference. The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups. The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group. On the Time Up and Go Test, no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups. For the 6 Minute Walk Test, both groups presented a statistically significant difference pre- and post-intervention, showing progress in their performance. The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term. Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group. In the lower extremity tests, the intervention patients showed more improvement than those subjected to traditional therapy. These results support that the Robot Gym can be as effective as traditional therapy for stroke patients, presenting a more cost- and labor-efficient option for countries with scarce clinical resources and funding. Trial registration ISRCTN98578807

Designing games for the rehabilitation of functional vision for children with cerebral visual impairment

Evidence has accumulated that visual rehabilitation for patients with neurological visual impairment can be effective. Unfortunately, the existing therapy tools are repetitive, uninteresting, and unsuitable for use with children. This project aims to improve the engaging qualities of visual rehabilitation for children, through the design of therapy tools based on game design principles. Development is ongoing in a participatory, user-centred manner in conjunction with a specialist centre for childhood visual impairment. This paper outlines design requirements and briefly reports early findings of the development process

Effects of isometric exercise on hypertension

Hypertension is a serious problem in modern society. Between the ages of 60 and 74, the prevalence of hypertension is almost double its age-adjusted prevalence among people under 60 years old. Physical activity and cardiorespiratory fitness are important influences on blood pressure. Most physical activity interventions have utilized aerobic exercise, but recent studies suggest that isometric exercise is safe and has favorable effects on physical fitness, hypertension, and the psychological status. Isometric exercise in hypertensive populations appears to maintain the reductions in blood pressure achieved by endurance training, and may even elicit further reductions in blood pressure. However, as I am indicating, resistance training is not the only recommended approach to lower blood pressure, but should play a prominent role in any program designed to do so