Activation pattern of rectus femoris during gait in subjects with stroke - an exploratory study of the loading phase

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Lower limb co-contraction during walking in subjects with stroke: A systematic review

a b s t r a c t Purpose: The aim of this paper was to identify and synthesise existing evidence on lower limb muscle cocontraction (MCo) during walking in subjects with stroke. Methods: An electronic literature search on Web of Science, PubMed and B-on was conducted. Studies from 1999 to 2012 which analysed lower limb MCo during walking in subjects with stroke, were included. Results: Eight articles met the inclusion criteria: 3 studied MCo in acute stage of stroke, 3 in the chronic stage and 2 at both stages. Seven were observational and 1 had a pretest-posttest interventional design. The methodological quality was ''fair to good'' to ''high'' quality (only 1 study). Different methodologies to assess walking and quantify MCo were used. There is some controversy in MCo results, however subjects with stroke tended towards longer MCo in both lower limbs in both the acute and chronic stages, when compared with healthy controls. A higher level of post-stroke walking ability (speed; level of independence) was correlated with longer thigh MCo in the non-affected limb. One study demonstrated significant improvements in walking ability over time without significant changes in MCo patterns. Conclusions: Subjects with stroke commonly present longer MCo during walking, probably in an attempt to improve walking ability. However, to ensure recommendations for clinical practice, further research with standardized methodologies is needed

A review of innovation strategies and processes to improve access to AT: Looking ahead to open innovation ecosystems.

It is essential to understand the strategies and processes which are deployed currently across the Assistive Technology (AT) space toward measuring innovation. The main aim of this paper is to identify functional innovation strategies and processes which are being or can be deployed in the AT space to increase access to AT globally. We conducted a scoping review of innovation strategies and processes in peer-reviewed literature databases and complemented this by identifying case studies demonstrating innovation strategies. The review includes WHO world region, publication year, AT type and a sector analysis against the Systems-Market for Assistive and Related Technologies Framework. We analyzed the case studies and interviews using thematic analysis. We included 91 papers out of 3,127 after review along with 72 case studies. Our results showed that product innovations were more prevalent than provision or supply innovations across papers and case studies. Case studies yielded two themes: open innovation (OI); radical and disruptive innovation. Financial instruments which encourage OI are needed and we recommend pursuing OI for AT innovation. Embedding AT within larger societal missions will be key to success governments and investors need to understand what AT is and their translational socioeconomic value

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Movement analysis of the upper limb during cyclic tasks

Historically the use of movement analysis as a tool for clinical diagnosis was predominantly employed in the analysis of human gait. Resultant data can then be analysed within a 2D framework using only the sagittal plane. When analysing these movements using 2D techniques, graphical software packages reconstruct the movement patterns of a trial using stick figure representations. These representations however provided limited information and were unable to address movements, which occurred in more than one, or a combination of planes as is evident with the upper limb. Therefore a technique was required to represent this planar movement, and is presented here. In 1982 Michael Whittle produced a trial that brought gait analysis into a 3D framework and along with it, the ability to study other parts of the body previously thought to be too complex for movement analysis techniques. 3D movement analysis was applied to various fields (i.e., rehabilitation, sports science, veterinary science, etc) and a trend recently developed in biomechanical research wherein the principles established by researchers in movement analysis of human gait where applied to the upper limb. The motivation for using movement analysis systems has also morphed from an emphasis on understanding the movements involved in prehensile tasks, to an aid for rehabilitation. The real advantage of implementing 3D techniques allows for a more useful and anatomically true representation. Trajectories and joint angles, indicated by marker placement are tracked during an experiment. This poster illustrates the progress of the project thus far, providing results of a normative data set of upper limb kinematics during prehensile tasks with the intention of analysing these results in comparison to a patient group in the latter stages of the project

Mobility and communication impairments and reintegration in the community in early walkers post-stroke

Patients who start walking early after stroke (early walkers) demonstrate the wish to return to meaningful social and vocational activities [1]. Poor community reintegration is common post-stroke: it is often associated with mobility impairments, such as walking deficits [2, 3] and most researchers have focused on understanding problems associated with reduced walking efficiency, i.e., balance, speed or distance impairments [4-6]. However, other impairments such as communication disorders, which affect 19% of patients [7], create additional barriers to successful socialisation and limit community participation[8]. Despite its importance, the impact of communication disorders on community participation in early walkers after stroke has received little attention. This study therefore aimed to describe mobility difficulties, communication and participation in the community and their relationship to recovery post-stroke.publishe

A narrative review on haptic devices: relating the physiology and psychophysical properties of the hand to devices for rehabilitation in central nervous system disorders

Purpose. This paper provides rehabilitation professionals and engineers with a theoretical and pragmatic rationale for the inclusion of haptic feedback in the rehabilitation of central nervous system disorders affecting the hand.Method. A narrative review of haptic devices used in sensorimotor hand rehabilitation was undertaken. Presented papers were selected to outline and clarify the underlying somatosensory mechanisms underpinning these technologies and provide exemplars of the evidence to date.Results. Haptic devices provide kinaesthetic and/or tactile stimulation. Kinaesthetic haptics are beginning to be incorporated in central nervous system rehabilitation, however, there has been limited development of tactile haptics. Clinical research in haptic rehabilitation of the hand is embryonic but initial findings indicate potential clinical benefit. Conclusions. Haptic rehabilitation offers the potential to advance sensorimotor hand rehabilitation but both scientific and pragmatic developments are needed to ensure that its potential is realised.<br/