Gait Measurements and Motor Recovery after Stroke

2000 Mathematics Subject Classification: 62P10, 92C20Gait analysis is one of the methods used for estimation of the degree of restoration of motor recovery after stroke. The purpose of the present study was to examine the diagnostic value of the footprint parameters and their relationship with the functional ambulation profile (FAP) scores provided automatically by the pressure sensor walkway system for gait examination. The patterns of walking were studied in a group of 23 patients with chronic unilateral stroke and 72 healthy subjects. Among the measured gait variables the peak times of the footprints were found as most informative parameters. Their predictive value was compared with some other gait indicators for motor recovery after stroke

Orthostatic Reactivity in Patients with Diabetic Neuropathy

AIM: The purpose of the study was to assess the effect of a structured physical therapy (PT) programme on the orthostatic reactivity in patients with diabetic neuropathy (DNP).MATERIAL AND METHODS: The study was performed in 90 patients with DNP (34 male and 56 female, mean ages 60.8 ± 7.8 years) of lower extremities. The orthostatic autoregulation was evaluated using an active orthostatic test. The arterial blood pressure and the heart rate were determined after 10 minutes of rest in lying position before and after 1, 5 and 10 minutes of active standing.RESULTS: At the start of the study a normotonic orthostatic reactivity (NOR) was observed in 32 patients. Abnormal sympathicotonic type of orthostatic reactivity (SOR) was found in 18 patients and asympaticotonic type of orthostatic reactivity (AOR) was established in the remaining 40 patients. After the PT treatment a significant improvement of the orthostatic autoregulation in the groups with SOR and AOR was not found – NOR was observed in 66 patients with DNP (80.3%) at 6 weeks after the start of PT.CONCLUSION: The applied structured PT, later continued as a home exercise programme, significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to DNP

Abnormal joint torque patterns exhibited by chronic stroke subjects while walking with a prescribed physiological gait pattern

<p>Abstract</p> <p>Background</p> <p>It is well documented that individuals with chronic stroke often exhibit considerable gait impairments that significantly impact their quality of life. While stroke subjects often walk asymmetrically, we sought to investigate whether prescribing near normal physiological gait patterns with the use of the Lokomat robotic gait-orthosis could help ameliorate asymmetries in gait, specifically, promote similar ankle, knee, and hip joint torques in both lower extremities. We hypothesized that hemiparetic stroke subjects would demonstrate significant differences in total joint torques in both the frontal and sagittal planes compared to non-disabled subjects despite walking under normal gait kinematic trajectories.</p> <p>Methods</p> <p>A motion analysis system was used to track the kinematic patterns of the pelvis and legs of 10 chronic hemiparetic stroke subjects and 5 age matched controls as they walked in the Lokomat. The subject's legs were attached to the Lokomat using instrumented shank and thigh cuffs while instrumented footlifters were applied to the impaired foot of stroke subjects to aid with foot clearance during swing. With minimal body-weight support, subjects walked at 2.5 km/hr on an instrumented treadmill capable of measuring ground reaction forces. Through a custom inverse dynamics model, the ankle, knee, and hip joint torques were calculated in both the frontal and sagittal planes. A single factor ANOVA was used to investigate differences in joint torques between control, unimpaired, and impaired legs at various points in the gait cycle.</p> <p>Results</p> <p>While the kinematic patterns of the stroke subjects were quite similar to those of the control subjects, the kinetic patterns were very different. During stance phase, the unimpaired limb of stroke subjects produced greater hip extension and knee flexion torques than the control group. At pre-swing, stroke subjects inappropriately extended their impaired knee, while during swing they tended to abduct their impaired leg, both being typical abnormal torque synergy patterns common to stroke gait.</p> <p>Conclusion</p> <p>Despite the Lokomat guiding stroke subjects through physiologically symmetric kinematic gait patterns, abnormal asymmetric joint torque patterns are still generated. These differences from the control group are characteristic of the hip hike and circumduction strategy employed by stroke subjects.</p

Evaluation of gait symmetry in poliomyelitis subjects : Comparison of a conventional knee ankle foot orthosis (KAFO) and a new powered KAFO.

Background: Compared to able-bodied subjects, subjects with post polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry. Objectives: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop- locked knee ankle foot orthosis (KAFO) or a newly developed powered KAFO. Methods: Seven subjects with poliomyelitis who routinely wore conventional KAFOs participated in this study, and received training to enable them to ambulate with the powered KAFO on level ground, prior to gait analysis. Results: There were no significant differences in the gait symmetry index (SI) of step length (P=0.085), stance time (P=0.082), double limb support time (P=0.929) or speed of walking (p=0.325) between the two test conditions. However, using the new powered KAFO improved the SI in step width (P=0.037), swing time (P=0.014), stance phase percentage (P=0.008) and knee flexion during swing phase (p≤0.001) compared to wearing the dropped locked KAFO. Conclusion: The use of a powered KAFO for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage and knee flexion during swing phase

Orthostatic Reactivity In Patients With Diabetic Neuropathy

The purpose of the study was to assess the effect of a structured physical therapy (PT) programme on the orthostatic reactivity in patients with diabetic neuropathy (DNP). The study was performed in 90 patients with DNP (34 male and 56 female, mean age 60.8±7.8 years) of lower extremities. The orthostatic autoregulation was evaluated using an active orthostatic test. The arterial blood pressure and the heart rate were determined after 10 minutes of rest in lying position before and after 1, 5 and 10 minutes of active standing. All patients had therapy with alpha-lipoic acid and a structured intensive 10 days PT program, later continued as a home exercise programme. The orthostatic autoregulation was evaluated three times – at the start of the study, at day 10 and at 6 weeks after the beginning of PT. The classification of Thulesius was used to divide the patients into 3 groups according to the type of their orthostatic reactivity. At the start of the study a normotonic orthostatic reactivity (NOR) was observed in 32 patients. Abnormal sympathicotonic type of orthostatic reactivity (SOR) was found in 18 patients and asympaticotonic type of orthostatic reactivity (AOR) was established in the remaining 40 patients. After the PT treatment a significant improvement of the orthostatic autoregulation in the groups with SOR and AOR was found – NOR was observed in 66 patients with DNP (80.3%) at 6 weeks after the start of PT. The applied structured PT, later continued as a home exercise programme, significantly improved the orthostatic reactivity in patients with orthostatic dysregulation due to DNP. Author Keywords: Exercise Therapy, Orthostatic Tolerance, Physical Therapy, Type II Diabete

Принципи на неврорехабилитация при мозъчен инсулт

Настоящото издание е посветено на болестите на нервната система и е продължение на учебника по обща неврология. То цели да обезпечи адекватен обем на теоретични и практически познания за диагноза, специфична терапия, поведение, интензивно лечение, профилактика, експертна оценка на трудоспособността и диспенсеризация на заболяванията на централната и периферната нервна система. Придобитите знания са съставна част от изискванията за амбулаторна и специализирана медицинска помощ по нервни болести и са насочени към формиране на практически умения за самостоятелна диагностично-лечебна, консултативна и експертна дейност по неврология. Учебникът е създаден като интердисциплинарно ръководство, предназначено за студенти по медицина, медицинска рехабилитация и кинезитерапия, общопрактикуващи лекари, специалисти в различни области на медицината, специализанти и докторанти, в чиято задължителна учебна програма са включени дисциплините „Нервни болести“ и „Кинезитерапия при нервни и психични болести“. Всеки обучаващ се трябва да усвои задължителен обем на теоретични и практически знания, определени като „Минимално изискуемо ниво на компетентност“ (МИНК). То е включено към всяка глава на учебника. Ръководството по клинична неврология е богато онагледено с учебни схеми, илюстрации и таблици. В него са отразени съвременните консенсуси за диагностика и поведение при различни неврологични заболявания и гранични с тях болести и синдроми, което го прави полезно помагало в ежедневната клинична практика. Учебникът завършва с преглед на Нобеловите награди в областта на невронауките, които са основа за прогресивното развитие на съвременната неврология