The effect of walking aids on muscle activation patterns during walking in stroke patients

The purpose of this study was to investigate changes in muscle activation patterns with respect to timing and amplitude that occur when subjects with stroke walk with and without a walking aid. This knowledge could help therapists in deciding whether or not patients should use a cane or quad stick while walking.\ud Thirteen patients suffering from a first unilateral ischemic stroke participated in the study. Surface electromyography (SEMG) of the erector spinae, gluteus maximus, gluteus medius, vastus lateralis, semitendinosus, gastrocnemius and tibialis anterior of the affected side were measured during three different conditions: (1) walking without a walking aid, (2) walking with a cane and (3) walking with a quad stick. Timing and amplitude parameters of the activation patterns were quantified using an objective burst detection algorithm and statistically evaluated.\ud Results showed a statistically significant and clinically relevant decrease in burst duration of both erector spinae and tibialis anterior when walking with a cane. The amplitude of the vastus lateralis and tibialis anterior dropped when patients walked with a cane and quad stick.\ud The use of a cane should be considered when therapy is given to stroke patients to achieve normal muscle activation patterns

The functional demand placed on the knee flexors and extensors of older adults when undertaking activities of daily living

The study describes activity patterns of rectus femoris (RF) and Vastii in 20 patients with chronic stroke who walked with a stiff-knee gait

An Electric Scooter Simulation Program for Training the Driving Skills of Stroke Patients with Mobility Problems: A Pilot Study

This paper describes an electric scooter simulation program and a first evaluation study in which we explored if it is possible to train the driving skills of future users of electric mobility scooters by means of an electric scooter simulation program in addition to conventional electric scooter training. Within this explorative study, 10 stroke survivors were randomly assigned to either the control (n = 5) or the electric scooter simulation intervention group (n = 5). Participants were assessed twice on the functional evaluating rating scale. During the followup measurement, subjective experiences regarding both forms of electric scooter training were elicited by a questionnaire. After a training period of 5 weeks, both groups improved on the Functional Evaluation Rating Scale. It can be concluded that the patients with stroke were satisfied with the electric scooter simulation training

An Electric Scooter Simulation Program for Training the Driving Skills of Stroke Patients with Mobility Problems: A Pilot Study

This paper describes an electric scooter simulation program and a first evaluation study in which we explored if it is possible to train the driving skills of future users of electric mobility scooters by means of an electric scooter simulation program in addition to conventional electric scooter training. Within this explorative study, 10 stroke survivors were randomly assigned to either the control (n = 5) or the electric scooter simulation intervention group (n = 5). Participants were assessed twice on the functional evaluating rating scale. During the followup measurement, subjective experiences regarding both forms of electric scooter training were elicited by a questionnaire. After a training period of 5 weeks, both groups improved on the Functional Evaluation Rating Scale. It can be concluded that the patients with stroke were satisfied with the electric scooter simulation training.Biomechanical EngineeringMechanical, Maritime and Materials Engineerin

Perceived spasticity in chronic spinal cord injured patients: Associations with psychological factors

Purpose: To explore the association between perceived spasticity and psychological factors (pain sensations, coping strategies, and illness cognitions) in chronic spinal cord injured (SCI) patients. - \ud Methods: Cross-sectional study using a set of questionnaires was designed for chronic complete patients with SCI and with self-reported leg spasticity. Outcome measures were Visual Analogue Scale for average perceived leg spasticity (VASSpasticity), VASPain for average perceived pain sensations in the leg, Utrecht Coping List (UCL) including its seven subscales, and Illness Cognition Questionnaire (ICQ) with its three subscales. Psychological factors with a bivariate correlation with VASSpasticity of p<0.2 were selected for regression analyses. - \ud Results: Nineteen patients with SCI (response rate 86%) participated. Bivariate correlations of p<0.2 were found between VASSpasticity and VASPain, UCLActive approach, UCLSeeking social support, UCLReassuring thoughts, ICQAcceptation, and ICQHelplessness. Only UCLReassuring thoughts (Beta −0.59, p=0.01) and ICQHelplessness (Beta 0.50, p=0.02) were retained in the multivariate model, explaining 44% of the variance in VASSpasticity (R2adjusted). - \ud Conclusions: Perceived spasticity appeared associated with psychological factors in complete patients with SCI: Those with higher levels of reassuring thoughts and lower levels of helplessness reported relatively lower levels of perceived spasticity. Large prospective cohort studies are recommended

Recovery of Gait After Stroke: What Changes?

Background. Little is known about whether changes in coordination patterns of muscle activation after stroke are related to functional recovery of walking. Objective . The present study investigated the longitudinal relationship between changes in neuromuscular activation patterns of paretic muscles in hemiplegic gait and improvement in walking ability after stroke. Methods. Thirteen patients diagnosed with a first unilateral ischemic stroke had their recovery of walking measured by the Rivermead Mobility Index, Functional Ambulation Categories, Barthel Index, Trunk Control Test, Motricity Index, and comfortable walking speed. Surface electromyography (SEMG) of the erector spinae, gluteus maximus, gluteus medius, rectus femoris, vastus lateralis, semitendinosus, gastrocnemius, and tibialis anterior muscles of both legs was used to quantify coordination patterns in comfortable walking mode. All clinical and electromyography-related measurements were taken at 3, 6, 9, 12, and 24 weeks poststroke. Timing parameters of the SEMG patterns were calculated, using an objective burst detection algorithm, and analyzed with the measures of functional recovery. Results . All functional measures, except Trunk Control Test, showed statistically significant improvement over time, whereas SEMG patterns did not change significantly over time. Conclusion. The lack of significant change in SEMG patterns over time suggests that functional gait improvements may be more related to compensatory strategies in muscle activation of the unaffected leg and biomechanical changes than by restitution of muscle coordination patterns in the affected leg. \ud \u

Stop using the Ashworth Scale for the assessment of spasticity.

Item does not contain fulltextAIM: Many studies have been performed on the methodological qualities of the (modified) Ashworth Scale but overall these studies seem inconclusive. The aim of this study was to investigate the construct validity and inter-rater reliability of the Ashworth Scale (AS) for the assessment of spasticity in the upper and lower extremities. METHOD: A cross-sectional study on spasticity in the elbow flexors (part 1) and knee extensors (part 2) was carried out. In both parts AS was assessed while muscle activity and resistance were recorded simultaneously in patients with upper motor neuron syndrome. Each patient was measured by three raters. RESULTS: 30 patients participated, 19 in each part of the study. For elbow flexor muscles, AS was not significantly associated with electromyographic parameters, except for rater 2 (rho = 0.66, p<0.01). A significant moderate association was found with resistance (0.54< or = rho < or =0.61, p<0.05). For knee extensors, AS scores were moderately associated with muscle activity (0.56< or = rho < or =0.66, p<0.05) and also with resistance (0.55< or = rho < or =0.87, p<0.05). The intraclass correlation coefficient for absolute agreement was 0.58 for elbow flexors and 0.63 for knee extensors. In linear mixed model analysis, the factor rater appeared to be highly associated with AS. CONCLUSION: The validity and reliability of the AS is insufficient to be used as a measure of spasticity.1 januari 201