Safety & efficacy of a robotic hip exoskeleton on outpatient stroke rehabilitation.

Objective: The objective of this study was to analyze the safety and efficacy of using a robotic hip exoskeleton designed by Samsung Electronics Co., Ltd., Korea, called the Gait Enhancing and Motivating System-Hip (GEMS-H), in assistance mode only with the poststroke population in an outpatient-rehabilitation setting.

The Association of Interlimb Coordination and Temporal Symmetry With Walking Function and Motor Impairment After Stroke.

Objective: Interlimb coordination during walking is impaired after stroke, with unknown effects on walking function. This cross-sectional study determined associations of interlimb coordination and temporal symmetry with walking function and motor impairment.

Design: During walking, participants wore wireless sensors to detect heel strikes.

Barriers to Enrollment in a Post-Stroke Neuromodulation and Walking Study: Implications for Recruiting Women.

Background: Women have a higher risk of stroke and related disability than men but are underrepresented in stroke clinical trials. Identifying modifiable recruitment and enrollment barriers for women can improve study generalizability, statistical power, and resource utilization.

Objective: In a post-stroke neuromodulation study, we determined the impact of sex on the occurrence of exclusion criteria and compared the sex distribution of screened and enrolled individuals with a broader stroke-affected population.

Concurrent validity of walking speed measured by a wearable sensor and a stopwatch during the 10-meter walk test in individuals with stroke.

Background: Walking speed is often measured with a stopwatch throughout stroke recovery. Wearable sensors also have been used recently to measure walking speed and provide information about spatiotemporal characteristics of walking.

Research Question: Do walking speeds measured with stopwatch and APDM wearable sensors have concurrent validity?

Methods: Individuals with chronic stroke (n = 62) performed the 10-meter walk test at comfortable and maximal speeds.

Understanding corticomotor mechanisms for activation of non-target muscles during unilateral isometric contractions of leg muscles after stroke.

Purpose: Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation.

Materials And Methods: Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion.

A cognitive task, deep breathing, and static stretching reduce variability of motor evoked potentials during subsequent transcranial magnetic stimulation.

Background: Motor evoked potentials (MEPs) induced via transcranial magnetic stimulation (TMS) demonstrate trial-to-trial variability limiting detection and interpretation of changes in corticomotor excitability. This study examined whether performing a cognitive task, voluntary breathing, or static stretching before TMS could reduce MEP variability.

Methods: 20 healthy young adults performed no-task, a cognitive task (Stroop test), deep breathing, and static stretching before TMS in a randomized order.

Functional connectivity of proximal and distal lower limb muscles and impact on gait variability in stroke.

Background: Higher gait variability after stroke increases risk of falls and compromises safe community ambulation. Corticomotor connectivity plays an important role in walking after stroke, however, its relation to gait variability remains unknown.

Research Question: Do corticomotor characteristics of the proximal and distal lower limb muscles predict gait variability in individuals with chronic stroke?

Methods: Retrospective analysis of data from 30 individuals with chronic stroke was conducted.

Motor overflow in the lower limb after stroke: Insights into mechanisms.

Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are as follows: (1) The contralesional hemisphere controls both limbs, and (2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke.

Discovering and comparing types of general practitioner practices using geolocational features and prescribing behaviours by means of K-means clustering.

Traditionally General Practitioner (GP) practices have been labelled as being in Rural, Urban or Semi-Rural areas with no statistical method of identifying which practices fall into each category. The main aim of this study is to investigate whether location and other characteristics can provide a tautology to identify different types of GP practice and compare the prescribing behaviours associated with the different practice types. To achieve this monthly open source prescription data were analysed by practice considering location, practice size, population density and deprivation rankings.

Symmetry Is Associated With Interlimb Coordination During Walking and Pedaling After Stroke.

Background And Purpose: Asymmetry during walking may be explained by impaired interlimb coordination. We examined these associations: (1) propulsive symmetry with interlimb coordination during walking, (2) work symmetry with interlimb coordination during pedaling, and (3) work symmetry and interlimb coordination with clinical impairment.

Methods: Nineteen individuals with chronic stroke and 15 controls performed bilateral, lower limb pedaling with a conventional device and a device with a bisected crank and upstroke assistance.

Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke.

Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb.

Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke.

Decreased walking speeds and spatiotemporal asymmetry both occur after stroke, but it is unclear whether and how they are related. It is also unclear whether rehabilitation-induced improvements in walking speed are associated with improvements in symmetry or greater asymmetry. High-intensity speed-based treadmill training (HISTT) is a recent rehabilitative strategy whose effects on symmetry are unclear.

Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke.

Background: Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes.

Objective: Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures.

Ipsilateral motor pathways to the lower limb after stroke: Insights and opportunities.

Stroke-related damage to the crossed lateral corticospinal tract causes motor deficits in the contralateral (paretic) limb. To restore functional movement in the paretic limb, the nervous system may increase its reliance on ipsilaterally descending motor pathways, including the uncrossed lateral corticospinal tract, the reticulospinal tract, the rubrospinal tract, and the vestibulospinal tract. Our knowledge about the role of these pathways for upper limb motor recovery is incomplete, and even less is known about the role of these pathways for lower limb motor recovery.

Walking test procedures influence speed measurements in individuals with chronic stroke.

Background: Walking speed measurements are clinically important, but varying test procedures may influence measurements and impair clinical utility. This study assessed the concurrent validity of walking speed in individuals with chronic stroke measured during the 10-m walk test with variations in 1) the presence of an electronic mat, 2) the speed measurement device, and 3) the measurement distance relative to the total test distance.

Methods: Twenty-five individuals with chronic stroke performed walking tests at comfortable and maximal walking speeds under three conditions: 1) 10-m walk test (without electronic mat) measured by stopwatch, 2) 10-m walk test (partially over an electronic mat) measured by software, and 3) 10-m walk test (partially over an electronic mat) measured by stopwatch.

Feasibility and Safety of Transcranial Direct Current Stimulation in an Outpatient Rehabilitation Setting After Stroke.

Transcranial direct current stimulation (tDCS) has strong potential for outpatient clinical use, but feasibility and safety of tDCS has only been evaluated in laboratory and inpatient clinical settings. The objective of this study was to assess feasibility and safety of tDCS for stroke in an outpatient clinical setting. Individuals with stroke in outpatient therapy received tDCS during physical therapy sessions.

Cortical priming strategies for gait training after stroke: a controlled, stratified trial.

Background: Stroke survivors experience chronic gait impairments, so rehabilitation has focused on restoring ambulatory capacity. High-intensity speed-based treadmill training (HISTT) is one form of walking rehabilitation that can improve walking, but its effectiveness has not been thoroughly investigated. Additionally, cortical priming with transcranial direct current stimulation (tDCS) and movement may enhance HISTT-induced improvements in walking, but there have been no systematic investigations.

Genetic polymorphisms for BDNF, COMT, and APOE do not affect gait or ankle motor control in chronic stroke: A preliminary cross-sectional study.

: Motor deficits after stroke are a primary cause of long-term disability. The extent of functional recovery may be influenced by genetic polymorphisms. : Determine the effect of genetic polymorphisms for brain-derived neurotrophic factor (), catechol-O-methyltransferase (), and apolipoprotein E () on walking speed, walking symmetry, and ankle motor control in individuals with chronic stroke.

Determinants of low bone mineral density in people with multiple sclerosis: Role of physical activity.

Background: People with multiple sclerosis (PwMS) have reduced bone mineral density (BMD), but the causes are unclear. Some factors that may cause reduced BMD in PwMS have been understudied, including physical activity, inflammation, cortisol, symptomatic fatigue, and depression. The aim of this study was to investigate factors that may uniquely contribute to reduced BMD in PwMS as compared to people without MS.

Impaired interlimb coordination is related to asymmetries during pedaling after stroke.

Objective: To understand whether lower limb asymmetry in chronic stroke is related to paretic motor impairment or impaired interlimb coordination.

Methods: Stroke and control participants performed conventional, unilateral, and bilateral uncoupled pedaling. During uncoupled pedaling, the pedals were mechanically disconnected.

Concurrent validity of the GAITRite electronic walkway and the 10-m walk test for measurement of walking speed after stroke.

Background: Walking speed is used to assess functional status, predict recovery, prescribe exercise, and track functional progress after stroke. Determining concurrent validity ensures that results from different tests of walking speed can be compared or used interchangeably. The GAITRite electronic walkway and the 10-m walk test (10MWT) are popular measurement tools of walking speed in the laboratory and in clinical settings, respectively.

Adjustments in Torque Steadiness During Fatiguing Contractions Are Inversely Correlated With IQ in Persons With Multiple Sclerosis.

Fatigue is one of the most debilitating symptoms of multiple sclerosis (MS), and the underlying mechanisms are poorly understood. When exposed to a physical or cognitive challenge, individuals with MS tend to exhibit greater declines in task performance (performance fatigability) and increased levels of self-reported fatigue (perceived fatigability), but these effects may be attenuated by greater intellectual capacity. The purpose of our study was to examine the influence of intelligence on fatigability in persons with MS.

Brain Activation During Passive and Volitional Pedaling After Stroke.

Background: Prior work indicates that pedaling-related brain activation is lower in people with stroke than in controls. We asked whether this observation could be explained by between-group differences in volitional motor commands and pedaling performance.

Methods: Individuals with and without stroke performed passive and volitional pedaling while brain activation was recorded with functional magnetic resonance imaging.

Administration of erythropoiesis-stimulating agents in patients undergoing haemodialysis: A time and motion study.

Background: International guidelines recommend treatment of anaemia due to chronic kidney disease (CKD) with erythropoiesis-stimulating agents (ESAs).

Objective: To document the time required and the cost in terms of nursing time to prepare and administer ESAs to patients on facility based haemodialysis (HD) with anaemia due to CKD before and after the introduction of long-acting ESAs.

Design: A time and motion study was implemented at four HD units in Australia to determine the time and costs associated with preparing and administering ESAs before and after the introduction of long-acting ESAs.

Motor unit activity in biceps brachii of left-handed humans during sustained contractions with two load types.

The purpose of the study was to compare the discharge characteristics of single motor units during sustained isometric contractions that required either force or position control in left-handed individuals. The target force for the two sustained contractions (24.9 ± 10.