Exercise Combined with Electrotherapy Enhances Motor Function in an Adolescent with Spinal Muscular Atrophy Type III

Background. Electrotherapy is widely used in physical therapy to increase muscle mass, improve motor function, and assist physical activity in several neurologic conditions. However, concerning Spinal Muscular Atrophy (SMA), limited evidence exists on the role of electrotherapy as an adjunct for improving muscle strength and function. Case Report. An adolescent (13 y.o.) with SMA type III underwent an 18-week strengthening program divided into two stages. During Phase I (weeks: 1-8), a home-based program for quadriceps strengthening through neuromuscular electrical stimulation (NMES) was provided. In Phase II (weeks: 9-18), at-home NMES was combined with functional electrical stimulation (FES) assisting volitional cycling for a broader, systemic conditioning. The treatment improved patient's structural and functional motor outcomes (quadriceps circumference and strength, Tinetti scale, and Hammersmith scale) as well as independence in stair climbing. Clinical Rehabilitation Impact. The purpose of this report is to raise awareness of the potential role of electrotherapy to help improving motor performance in SMA patients and, secondly, to foster further research aimed at assessing the actual contribution this intervention may have as an add-on therapy to existing care

Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors

This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p=0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6±1.0 to 1.1±1.0; p=0.001) and fingers (from 1.2±1.1 to 0.7±0.9; p=0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123

Relationship between Lower Limbs Performance and Spinal Alignment in Parkinson’s Disease Patients: An Observational Study with Cross Sectional Design

Parkinson’s disease (PD) is a progressive neurodegenerative disease determining spinal deformities and muscle rigidity, weakness and dystonia that can be related to a change in muscular output during sit-to-stand tasks (STS). Purpose: The aim of this study was to determine the impacts of spinal alignment on lower limbs performance during STS tasks in Parkinson’s disease (PD) patients and healthy controls. Methods: In total, 43 consecutive PD patients (“PD” Group, 25 males and 18 females; age 73.7 ± 7.1) and 42 people not affected by any type of neurological disease (“CON” Group, 22 males, 20 females; age 69.8 ± 6.0) participated in the observational study. The clinical assessment included: IPAQ (International Physical Activity Questionnaire), Hoehn Yahr score, plumb-line distance from the spinous process of C7, kyphosis apex and the spinous process of L3 and S1. We used the Muscle Quality Index test (MQI) to assess muscle power output during STS in both groups. Results: The MQI test measurements of absolute and relative lower limb power was significantly lower in the PD group, in addition to a negative correlation with age and a positive correlation with PL-L3 in that group of patients. Conclusions: A final consideration regarding our results leads to the possibility that the preservation of lumbar lordosis may be one of the factors for maintaining efficient biomechanics of the lower limb muscles, with the preservation of the physiological contractile characteristics of these muscles being the objective for a multidisciplinary rehabilitation based on postural exercises of the spine and a program of training exercises for the lower limb muscles

Influence of workload and posture on handcycling efficiency

Handbike (HB) is an arm propelled device of locomotion for subjects with lower limbs disabilities. Handcycling has become a Paralympics discipline, increasing the need to study how lesion level may influence posture on HB and energy cost during exercise. The aim was also to test how postures different from the free chosen one might influence functional parameters during exercise

Design of Medical Devices with Usability in Mind: A Theoretical Proposal and Experimental Case Study Using the LEPRE Device

Usability is a critical product feature and is required for widespread market adoption. Standards on usability are highly focused on evaluation procedures and specific aspects, such as software issues or human–machine interaction, whereas the relative scientific literature is very normative oriented. The few methodological works dealing with usability either consider it as one of the many attributes that a particular project must satisfy or present very general methods. No design methods systematically oriented toward the integration of usability and usability-related constraints have been developed to date. This paper presents a usability-oriented model for the design of medical devices and its application to the design of LEPRE, a medical device for upper- and lower-limb robotic rehabilitation. Two methods were used to assess the device’s usability: interviews with experts to outline qualitative evaluations and System Usability Scale (SUS) questionnaires on eight physiotherapists, two physiatrists, and 12 patients, enabling a quantitative assessment. Results support the intention of providing an integrated methodological approach to be applied from the early stages of the project, thus saving time and costs, leading to a more linear product development for this application