Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials

To identify the gait parameters used to assess gait disorders in children with bilateral spastic cerebral palsy ( BSCP) and evaluate their responsiveness to treatments : A systematic search within Pubmed, Web of Science and Scopus ( English, 2000 - 2016) for randomized controlled trials of children with BSCP who were assessed by i nstrumented gait analysis ( IGA ) was done . Data r elated to participants and study characteristics, risk of bias and outcome measures w ere collected . A list of gait parameters responsive to clinical interventions was obtained. Results : Twenty - one articles met the inclusion criteria. Eighty - nine gait parameters were identified and fifty - six of them showed responsiveness to treatments . Spatiotemporal and kinematic parameters were widely used compared to kinetic and surface electromyography data . The majority of responsive gait parameters were joint angles at the sagittal plane (flexion - extension) . The IGA yields responsive outcome measure s for the gait assessment of children with BSCP . Spatiotemporal and kinematic parameters are the gait parameters used most frequently . Further research is needed to establish the relevant gait parameters for each clinical problem.Peer ReviewedPostprint (author's final draft

Gait event detection using kinematic data in children with bilateral spastic cerebral palsy

Background. Ground reaction forces are the gold standard for detecting gait events, but they are not always applicable in cerebral palsy. Gait event detection using kinematic data in children with bilateral spastic cerebral palsy is an event detection method based on the sagittal plane velocity of heel and toe markers. We aimed to evaluate whether Ghoussayni's algorithm, using two different thresholds, was a valid event detection method in children with bilateral spastic cerebral palsy. We also aimed to define a new adaptation of Ghoussayni's algorithm for detecting foot strike in cerebral palsy, and study the effect of event detection methods on spatiotemporal parameters. Methods. Synchronized kinematic and kinetic data were collected retrospectively from 16 children with bilateral spastic cerebral palsy (7 males and 9 females; age 8.9 ± 2.7 years) walking barefoot at self-selected speed. Gait events were detected using methods: 1) ground reaction forces, 2) Ghoussayni's algorithm with a threshold of 0.5 m/s, and 3) Ghoussayni's algorithm with a walking speed dependent threshold. The new adaptation distinguished how foot strikes were performed (heel and/or toe) comparing the timing when the foot markers velocities fell below the threshold. Differences between the three methods, and between spatiotemporal parameters calculated from the two Ghoussayni's thresholds were analyzed. Findings. There were statistically significant (P < 0.05) differences between methods 1 and 3, and between some spatiotemporal parameters calculated from methods 2 and 3. Ghoussayni's algorithm showed better performance for foot strike than for toe off. Interpretation. Ghoussayni's algorithm using 0.5 m/s is valid in children with bilateral spastic cerebral palsy. Event detection methods affect spatiotemporal parameters.Peer ReviewedPostprint (published version

Assessment of trunk flexion in arm reaching tasks with electromyography and smartphone accelerometry in healthy human subjects

Reproducció del document publicat a: https://doi.org/10.1038/s41598-021-84789-3Trunk stability is essential to maintain upright posture and support functional movements. In this study, we aimed to characterize the muscle activity and movement patterns of trunk flexion during an arm reaching task in sitting healthy subjects and investigate whether trunk stability is affected by a startling acoustic stimulus (SAS). For these purposes, we calculated the electromyographic (EMG) onset latencies and amplitude parameters in 8 trunk, neck, and shoulder muscles, and the tilt angle and movement features from smartphone accelerometer signals recorded during trunk bending in 33 healthy volunteers. Two-way repeated measures ANOVAs were applied to examine the effects of SAS and target distance (15 cm vs 30 cm). We found that SAS markedly reduced the response time and EMG onset latencies of all muscles, without changing neither movement duration nor muscle recruitment pattern. Longer durations, higher tilt angles, and higher EMG amplitudes were observed at 30 cm compared to 15 cm. The accelerometer signals had a higher frequency content in SAS trials, suggesting reduced movement control. The proposed measures have helped to establish the trunk flexion pattern in arm reaching in healthy subjects, which could be useful for future objective assessment of trunk stability in patients with neurological affections.This work was supported in part by a fellowship from “La Caixa” Foundation (ID 100010434) with fellowship code LCF/BQ/DE18/11670019, in part by the Secretaria d’Universitats i Recerca de la Generalitat de Catalunya under Grant GRC 2017 SGR 01770, in part by the Agencia Estatal de Investigación, the Spanish Ministry of Science, Innovation and Universities, and the European Regional Development Fund under Grant RTI2018 098472-B-I00, in part by the CERCA Program/Generalitat de Catalunya, in part by H2020-ERA-NET Neuron under Grant AC16/00034, in part by La Marató de TV3 2017 under Grant 201713.31, and in part by Premi Beca “Mike Lane” 2019—Castellers de la Vila de Gràcia

Quantitative evaluation of trunk function and the StartReact effect during reaching in patients with cervical and thoracic spinal cord injury

Reproducció del document publicat a: https://doi.org/10.1088/1741-2552/ac19d3Objective. Impaired trunk stability is frequent in spinal cord injury (SCI), but there is a lack of quantitative measures for assessing trunk function. Our objectives were to: (a) evaluate trunk muscle activity and movement patterns during a reaching task in SCI patients, (b) compare the impact of cervical (cSCI) and thoracic (tSCI) injuries in trunk function, and (c) investigate the effects of a startling acoustic stimulus (SAS) in these patients. Approach. Electromyographic (EMG) and smartphone accelerometer data were recorded from 15 cSCI patients, nine tSCI patients, and 24 healthy controls, during a reaching task requiring trunk tilting. We calculated the response time (RespT) until pressing a target button, EMG onset latencies and amplitudes, and trunk tilt, lateral deviation, and other movement features from accelerometry. Statistical analysis was applied to analyze the effects of group (cSCI, tSCI, control) and condition (SAS, non-SAS) in each outcome measure. Main results. SCI patients, especially those with cSCI, presented significantly longer RespT and EMG onset latencies than controls. Moreover, in SCI patients, forward trunk tilt was accompanied by significant lateral deviation. RespT and EMG latencies were remarkably shortened by the SAS (the so-called StartReact effect) in tSCI patients and controls, but not in cSCI patients, who also showed higher variability. Significance. The combination of EMG and smartphone accelerometer data can provide quantitative measures for the assessment of trunk function in SCI. Our results show deficits in postural control and compensatory strategies employed by SCI patients, including delayed responses and higher lateral deviations, possibly to improve sitting balance. This is the first study investigating the StartReact responses in trunk muscles in SCI patients and shows that the SAS significantly accelerates RespT in tSCI, but not in cSCI, suggesting an increased cortical control exerted by these patients.This work was developed in the framework of the joint project 'Biomedical signal interpretation to study motor impairment, neurological disorders and novel personalised neurorehabilitation therapies', between the Fundación Institut Guttmann and the Institute for Bioengineering of Catalonia. This work was supported in part by a fellowship from 'La Caixa' Foundation (ID 100010434) with fellowship code LCF/BQ/DE18/11670019, in part by the Secretaria d'Universitats i Recerca de la Generalitat de Catalunya under Grant GRC 2017 SGR 01770, in part by the Agencia Estatal de Investigación, the Spanish Ministry of Science, Innovation and Universities, and the European Regional Development Fund under Grant RTI2018 098472-B-I00, in part by the CERCA Program/Generalitat de Catalunya, in part by H2020-ERA-NET Neuron under Grant AC16/00034, in part by La Marató de TV3 2017 under Grant 201713.31, and in part by Premi Beca 'Mike Lane' 2019—Castellers de la Vila de Gràcia. The authors declare no competing interests

ABLE: assistive biorobotic low-cost exoskeleton

Robotic gait training after spinal cord injury is of high priority to maximize independence and improve the health condition of these patients. Current rehabilitation robots are expensive and heavy, and are generally found only in the clinic. To overcome these issues, we present the design of a low-cost, low-weight, personalized and easy-to-use robotic exoskeleton for incomplete spinal cord injured subjects based on simple modular components that are assembled on the current passive orthopedic supports. The paper also presents a preliminary experimental assessment of the assistive device on one subject with spinal cord injury that can control hip flexion, but lacks control of knee and ankle muscles. Results show that gait velocity, stride length and cadence of walking increased (24,11%, 7,41% and 15,56%, respectively) when wearing the robotic exoskeleton compared to the case when the subject used the usual passive supports.Postprint (author's final draft

Características del dolor neuropático crónico y su relación con el bienestar psicológico en pacientes con lesión medular

Objetivos. Determinar la prevalencia del dolor neuropático (DN) en una muestra de pacientes con lesión medular (LM), examinar la relación entre las características clínicas, demográficas y psicológicas con la prevalencia del DN después de una LM y a su vez con los diferentes tipos de DN, y estudiar el valor predictivo de los factores más significativos. Pacientes y métodos. Estudio transversal observacional de un total de 260 pacientes que acudieron a una revisión anual. Las principales medidas de resultados incluyeron presencia/ausencia de DN, índice de bienestar psicológico, historia detallada del dolor y escala de puntuación numérica de 0-10 para la media de intensidad del dolor. Resultados. 93 pacientes (36%) con LM tenían DN. De los pacientes que presentaron DN, un 35% mostró dolor a nivel de la lesión, mientras que un 65% presentó DN por debajo. La única variable con capacidad predictiva sobre la prevalencia del DN fue la edad en el momento de la LM. Se observaron diferencias estadísticamente significativas entre la prevalencia del DN y la percepción de bienestar psicológico; el grupo de pacientes con DN fue el que tuvo proporcionalmente un malestar psicológico mayor. En cuanto a los diferentes tipos de DN, las variables con capacidad predictiva sobre la clasificación del DN eran el inicio temprano del dolor en el DN a nivel y el hecho de que la lesión sea incompleta en el DN por debajo. Conclusión. El DN aparece con frecuencia después de la LM y se da de forma más común en aquellos pacientes que han sufrido la lesión a edades más avanzadas. El DN tiene un impacto negativo en la percepción de bienestar psicológicoAIMS. To determine the prevalence of neuropathic pain (NP) in a sample of patients with spinal cord injury (SCI), to examine the relation between clinical, demographic and psychological characteristics with the prevalence of NP after SCI and the different types of NP, and to study predictive factors. PATIENTS AND METHODS. Transversal observational study of 260 patients who attended their annual revision. Main outcome measures included presence/absence of NP, psychological well-being index, detailed pain history and 0-10 numerical rating scale of average pain intensity. RESULTS. 93 patients (36%) with SCI had NP. Of the patients with NP, 35% showed pain at level, while 65% showed NP below the level of injury. The only variable with a predictive value on the prevalence of NP was older age at the time of SCI. Statistically significant differences were observed between the prevalence of NP and the perception of psychological well-being; patients with NP were the ones with more psychological distress. As for the different types of NP, the variables with predictive value on the classification of NP were early onset of pain at level, and incompleteness of the lesion in the below level NP. CONCLUSION. The results of this study show that NP appears frequently after SCI being more prevalent in patients who suffered the injury at more advanced ages. NP has a negative impact on the perception of psychological well-bein

Transcutaneous Electrical Neuromodulation of the Cervical Spinal Cord Depends Both on the Stimulation Intensity and the Degree of Voluntary Activity for Training. A Pilot Study

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation offers promise in improving hand function. However, it is still unknown which stimulus intensity or which muscle force level could be better for this improvement. Nine healthy individuals received the following interventions: (i) eEmc intensities at 80%, 90% and 110% of abductor pollicis brevis motor threshold combined with hand training consisting in 100% handgrip strength; (ii) hand training consisting in 100% and 50% of maximal handgrip strength combined with 90% eEmc intensity. The evaluations included box and blocks test (BBT), maximal voluntary contraction (MVC), F wave persistency, F/M ratio, spinal and cortical motor evoked potentials (MEP), recruitment curves of spinal MEP and cortical MEP and short-interval intracortical inhibition. The results showed that: (i) 90% eEmc intensity increased BBT, MVC, F wave persistency, F/M ratio and cortical MEP recruitment curve; 110% eEmc intensity increased BBT, F wave persistency and cortical MEP and recruitment curve of cortical MEP; (ii) 100% handgrip strength training significantly modulated MVC, F wave persistency, F/M wave and cortical MEP recruitment curve in comparison to 50% handgrip strength. In conclusion, eEmc intensity and muscle strength during training both influence the results for neuromodulation at the cervical level

Cervical electrical neuromodulation effectively enhances hand motor output in healthy subjects by engaging a use-dependent intervention

Electrical enabling motor control (eEmc) through transcutaneous spinal cord stimulation is a non-invasive method that can modify the functional state of the sensory-motor system. We hypothesize that eEmc delivery, together with hand training, improves hand function in healthy subjects more than either intervention alone by inducing plastic changes at spinal and cortical levels. Ten voluntary participants were included in the following three interventions: (i) hand grip training, (ii) eEmc, and (iii) eEmc with hand training. Functional evaluation included the box and blocks test (BBT) and hand grip maximum voluntary contraction (MVC), spinal and cortical motor evoked potential (sMEP and cMEP), and resting motor thresholds (RMT), short interval intracortical inhibition (SICI), and F wave in the abductor pollicis brevis muscle. eEmc combined with hand training retained MVC and increased F wave amplitude and persistency, reduced cortical RMT and facilitated cMEP amplitude. In contrast, eEmc alone only increased F wave amplitude, whereas hand training alone reduced MVC and increased cortical RMT and SICI. In conclusion, eEmc combined with hand grip training enhanced hand motor output and induced plastic changes at spinal and cortical level in healthy subjects when compared to either intervention alone. These data suggest that electrical neuromodulation changes spinal and, perhaps, supraspinal networks to a more malleable state, while a concomitant use-dependent mechanism drives these networks to a higher functional state

Adaptación a la altura y a ambientes fríos en personas con lesión medular

Objetivo: estudiar las diferencias en la adaptación respiratoria al ejercicio en condiciones medioambientales similares a las de la práctica de los deportes de invierno, entre personas físicamente activas y sanas con lesión medular y sin lesión medular. Material y método: participaron 24 voluntarios sanos y físicamente activos, 12 presentaban en su historia una lesión medular y los otros 12 no. Cada sujeto realizó tres pruebas de esfuerzo máximas con monitorización ventilatoria, pero modificando las circunstancias ambientales: a nivel del mar y a 22 - 24º C; a 3.000 metros de altura simulada y a 22 - 24º C, y a 3.000 metros de altura simulada y a 5 - 6º C. Resultados: al comparar los valores observados en las pruebas de altura simulada respecto a la realizada a nivel del mar, se observó un aumento significativo de los valores del consumo de VO2 y de la producción del VCO2. Este aumento no se acompañó de modificaciones en la ventilación, la frecuencia respiratoria o el volumen corriente. Paralelamente, la fracción espirada para el O2 y el CO2, el equivalente respiratorio para el O2 y el CO2 o la presión al final de la espiración para el O2 y el CO2 mostraron cambios estadísticamente significativos. Conclusiones: la realización de un esfuerzo intenso produce importantes cambios ventilatorios con necesidades de oxígeno superiores para una altura simulada de 3.000 metros que no cambian sustancialmente con el frío

Efecto de la suplementación de la dieta con ácidos grasos del tipo n-3 sobre la capacidad funcional de los lesionados medulares.

[spa] De las numerosas discapacidades que pueden afectar a la humanidad, la lesión o enfermedad grave de la médula espinal constituye una de las calamidades más devastadoras en la vida de una persona. Recientemente, se ha producido un progresivo interés en el estudio de las alteraciones crónicas de la función cardiovascular, causa de una reducción de la capacidad al ejercicio de muchos lesionados medulares, así como del aumento de la morbi-mortalidad. Datos recientes muestran que las alteraciones cardiovasculares se han convertido en la primera causa de mortalidad entre las personas afectas de una LM. La posibilidad de conocer con detalle estas alteraciones representa el primer paso de cara a reducir factores de riesgo y así posibilitar mejoras en la calidad de vida y longevidad en los lesionados medulares. En las personas afectas de una lesión medular, la capacidad física se encuentra reducida debido a la pérdida directa del control motor y de la regulación simpática por debajo del nivel lesional. Los clínicos e investigadores en el campo de la neurorrehabilitación necesitan encontrar y poder comparar valores para los diferentes componentes de la actividad física (consumo de oxígeno, fuerza muscular de miembros superiores y función respiratoria), de cara a determinar cuales son los focos de atención de la rehabilitación. Es necesario poder monitorizar los cambios de la actividad física para conocer la eficacia y efectividad de los programas de rehabilitación a los que son sometidos las personas que han sufrido una lesión medular. El objetivo de la tesis, es la de integrar los diferentes componentes de la actividad física del sujeto que ha sufrido una lesión medular, su adaptación fisiológica al ejercicio, el análisis de que factores pueden influir en la calidad de vida de este colectivo, el análisis de los valores cardiorrespiratorios en respuesta al ejercicio comparados con sujetos normales y cuales son las posibles actuaciones que podemos realizar de cara a reducir los factores de riesgo cardiovascular, más habituales en los lesionados medulares que en la población general, y en definitiva, intentar incidir en parámetros de calidad de vida. Como conclusiones destacaremos que la adaptación a la actividad física en esta población muestra unas características específicas y, deben ser evaluadas de esta manera, proponiendo un cálculo teórico de consumo máximo de 02 diferente en los lesionados medularesel. Asimismo debemos intentar incrementar la actividad física en los lesionados medulares, ya que el desplazamiento en silla de ruedas o los ejercicios realizados en un programa de rehabilitación convencional no son suficientes de cara a mejorar indicadores de salud. El suplemento con ácidos grasos del grupo omega-3, aunque parece que puede reducir la mortalidad por enfermedad cardiovascular en la población LM estudiada, no se observaron modificaciones en el pérfil lipídico como factor de riesgo. Finalmente, el suplemento con ácidos grasos del grupo omega-3 ha demostrado que mejora de forma significativa la capacidad funcional de los lesionados medulares, sobre todo en los diferentes parámetros relacionados con la evaluación de la fuerza