Increased Lower Limb Spasticity but Not Strength or Function Following a Single-Dose Serotonin Reuptake Inhibitor in Chronic Stroke

Objective: To investigate the effects of single doses of a selective serotonin reuptake inhibitor (SSRI) on lower limb voluntary and reflex function in individuals with chronic stroke. Design: Double-blind, randomized, placebo-controlled crossover trial. Setting: Outpatient research setting. Participants: Individuals (N=10; 7 men; mean age ± SD, 57±10y) with poststroke hemiplegia of \u3e1 year duration who completed all assessments. Interventions: Patients were assessed before and 5 hours after single-dose, overencapsulated 10-mg doses of escitalopram (SSRI) or placebo, with 1 week between conditions. Main Outcome Measures: Primary assessments included maximal ankle and knee isometric strength, and velocity-dependent (30°/s–120°/s) plantarflexor stretch reflexes under passive conditions, and separately during and after 3 superimposed maximal volitional drive to simulate conditions of increased serotonin release. Secondary measures included clinical measures of lower limb coordination and locomotion. Results: SSRI administration significantly increased stretch reflex torques at higher stretch velocities (eg, 90°/s; P=.03), with reflexes at lower velocities enhanced by superimposed voluntary drive (P=.02). No significant improvements were seen in volitional peak torques or in clinical measures of lower limb function (lowest P=.10). Conclusions: Increases in spasticity but not strength or lower limb function were observed with single-dose SSRI administration in individuals with chronic stroke. Further studies should evaluate whether repeated dosing of SSRIs, or as combined with specific interventions, is required to elicit significant benefit of these agents on lower limb function poststroke

Perception of Lower Extremity Loads in Stroke Survivors

Objective: This study aimed to improve our understanding of static and dynamic lower extremity sensory perception and the impact of sensory impairments on the control of walking in stroke survivors. Methods: Using a custom, real-time unloading system, we tested load perception at heel strike, mid stance and push off in 10 stroke survivors and compared their performance to 10 age-matched and 5 young adult control subjects. Dynamic load perception was based on a judgment of which leg was bearing more load, which was altered on a step by step basis. We also examined lower extremity static load perception, coordination, proprioception, balance, and gait symmetry. Results: The stroke survivors performed significantly worse than the control subjects in dynamic load perception, coordination, proprioception, balance and gait symmetry. Gait symmetry correlated with static and dynamic load perception measures but not with age, proprioception, coordination, and balance. Conclusions: Sensory deficits related to load detection in the impaired limb could result in an increased uncertainty of limb load and a gait strategy in which stroke survivors minimize loading of the impaired limb. Significance: This new method of measuring lower extremity dynamic load perception provides a framework for understanding gait-related sensory impairments in stroke survivors

Effects of break crops, and of wheat volunteers growing in break crops or in set-aside or conservation covers, all following crops of winter wheat, on the development of take-all (Gaeumannomyces graminis var. tritici) in succeeding crops of winter wheat

Experiments on the Rothamsted and Woburn Experimental Farms studied the effects on take-all of different break crops and of set-aside/conservation covers that interrupted sequences of winter wheat. There was no evidence for different effects on take-all of the break crops per se but the presence of volunteers, in crops of oilseed rape, increased the amounts of take-all in the following wheat. Severity of take-all was closely related to the numbers of volunteers in the preceding break crops and covers, and was affected by the date of their destruction. Early destruction of set-aside/conservation covers was usually effective in preventing damaging take-all in the following wheat except, sometimes, when populations of volunteers were very large. The experiments were not designed to test the effects of sowing dates but different amounts of take-all in the first wheats after breaks or covers apparently affected the severity of take-all in the following (second) wheats only where the latter were relatively late sown. In earlier-sown second wheats, take-all was consistently severe and unrelated to the severity of the disease in the preceding (first) wheats. Results from two very simple experiments suggested that substituting set-aside/conservation covers for winter wheat, for 1 year only, did not seriously interfere with the development of take-all disease or with the development or maintenance of take-all decline (TAD). With further research, it might be possible for growers wishing to exploit TAD to incorporate set-aside/conservation covers into their cropping strategies, and especially to avoid the worst effects of the disease on grain yield during the early stages of epidemics

Review of the literature on individual education plans

Aims and Scope of the Review - this review was carried out under a contract with the New Zealand Ministry of Education, which contained the following requirements: A literature review of national and international developments in the use of the Individual Education Plan (IEP) with schools and families, with particular attention to special education assessment practice(s) and their relationship to the IEP process. The purposes of the review were defined as follows: 1. To undertake a literature review of national and international developments in IEP processes and special education assessment practice to contribute to the Ministry of Education’s current project to review, revise and position the Individual Education Programme (IEP) Guidelines in relation to: the New Zealand Curriculum (Ministry of Education 2007), current assessment practices, effective teaching and learning practices, and engagement and reporting to parents, family and whanau (National Standards). 2. To provide both New Zealand and international research evidence of effective and/or evidence based practice, which, along with the data being collected by the Ministry of Education project team, will ultimately inform the future use of IEPs. The scope of the review was defined as follows: 1. The focus of the review is to be on: students with special needs in all school sector settings, students as learners, not the disability or the diagnosis they present with, the use of IEPs with schools and parents, the role of special education staff and other agencies in the IEP process, and what makes the IEP process effective for schools, students and their families, and what evidence there is of their effectiveness, with particular reference to the educational implications. 2. The literature sourced will include studies from both New Zealand and overseas, and peer reviewed journals and other publications

A Novel Cable-Driven Robotic Training Improves Locomotor Function in Individuals Post-Stroke

A novel cable-driven robotic gait training system has been tested to improve the locomotor function in individuals post stroke. Seven subjects with chronic stroke were recruited to participate in this 6 weeks robot-assisted treadmill training paradigm. A controlled assistance force was applied to the paretic leg at the ankle through a cable-driven robotic system. The force was applied from late stance to mid-swing during treadmill training. Body weight support was provided as necessary to prevent knee buckling or toe drag. Subjects were trained 3 times a week for 6 weeks. Overground gait speed, 6 minute walking distance, and balance were evaluated at pre, post 6 weeks robotic training, and at 8 weeks follow up. Significant improvements in gait speed and 6 minute walking distance were obtained following robotic treadmill training through a cable-driven robotic system. Results from this study indicate that it is feasible to improve the locomotor function in individuals post stroke through a flexible cable-driven robot

A Modular Robotic System with Applications to Space Exploration

Modular robotic systems offer potential advantages as versatile, fault-tolerant, cost-effective platforms for space exploration, but a sufficiently mature system is not yet available. We describe the possible applications of such a system, and present prototype hardware intended as a step in the right direction. We also present elements of an automated design and optimization framework aimed at making modular robots easier to design and use, and discuss the results of applying the system to a gait optimization problem. Finally, we discuss the potential near-term applications of modular robotics to terrestrial robotics research

Effects of Training Intensity on Locomotor Performance in Individuals With Chronic Spinal Cord Injury: A Randomized Crossover Study

Background. Many physical interventions can improve locomotor function in individuals with motor incomplete spinal cord injury (iSCI), although the training parameters that maximize recovery are not clear. Previous studies in individuals with other neurologic injuries suggest the intensity of locomotor training (LT) may positively influence walking outcomes. However, the effects of intensity during training of individuals with iSCI have not been tested. Objective. The purpose of this pilot, blinded-assessor randomized trial was to evaluate the effects of LT intensity on walking outcomes in individuals with iSCI. Methods. Using a crossover design, ambulatory participants with iSCI \u3e1 year duration performed either high- or low-intensity LT for ≤20 sessions over 4 to 6 weeks. Four weeks following completion, the training interventions were alternated. Targeted intensities focused on achieving specific ranges of heart rate (HR) or ratings of perceived exertion (RPE), with intensity manipulated by increasing speeds or applying loads. Results. Significantly greater increases in peak treadmill speeds (0.18 vs 0.02 m/s) and secondary measures of metabolic function and overground speed were observed following high- versus low-intensity training, with no effects of intervention order. Moderate to high correlations were observed between differences in walking speed or distances and differences in HRs or RPEs during high- versus low-intensity training. Conclusion. This pilot study provides the first evidence that the intensity of stepping practice may be an important determinant of LT outcomes in individuals with iSCI. Whether such training is feasible in larger patient populations and contributes to improved locomotor outcomes deserves further consideration

Prolonged Quadriceps Activity Following Imposed Hip Extension: A Neurophysiological Mechanism for Stiff-Knee Gait?

The biomechanical characteristics of stiff knee gait following neurological injury include decreased knee flexion velocity at toe-off, which may be due to exaggerated quadriceps activity. The neuromuscular mechanism underlying this abnormal activity is unclear, although hyperexcitable heteronymous reflexes may be a source of impaired coordination. The present study examines the contribution of reflex activity from hip flexors on knee extensors following stroke and its association with reduced swing-phase knee flexion during walking. Twelve individuals poststroke and six control subjects were positioned in supine on a Biodex dynamometer with the ankle and knee held in a static position. Isolated hip extension movements were imposed at 60, 90, and 120°/s through a 50° excursion to end-range hip extension. Reflexive responses of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) were quantified during and after the imposed hip rotation. Gait analysis was also performed for all subjects in the stroke group. In subjects with stroke, imposed hip extension evoked a brief reflexive response in the quadriceps, followed by a heightened level of sustained activity. The initial response was velocity dependent and was larger in the stroke group than in the control group. In contrast, the prolonged response was not velocity dependent, was significantly greater in the VL and RF in subjects with stroke, and, importantly, was correlated to decreased swing-phase knee flexion. Hyperexcitable heteronymous connections from hip flexors to knee extensors appear to elicit prolonged quadriceps activity and may contribute to altered swing-phase knee kinematics following stroke