Functional resistance training during walking: do biomechanical and neural effects differ based on targeted joints?

Devices for functional resistance training (FRT) during walking are often configured to resist the knee or both the hip and knee joints. Adding resistance to the hip in addition to the knee should alter the effects of training; however, these configurations have not been directly compared. We examined how FRT during walking differs during the knee or hip and knee conditions.

Rest the brain to learn new gait patterns after stroke.

Background: The ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these studies could be confounded by the presence of significant motor impairments.

Altered Corticospinal and Intracortical Excitability After Stroke: A Systematic Review With Meta-Analysis.

Background: Intracortical inhibitory/faciliatory measures are affected after stroke; however, the evidence is conflicting.

Objective: This meta-analysis aimed to investigate the changes in motor threshold (MT), motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF), and identify sources of study variability using a machine learning approach.

Methods: We identified studies that objectively evaluated corticospinal excitability and intracortical inhibition/facilitation after stroke using transcranial magnetic stimulation.

Design and Validation of a Pancake Style Planetary Gearbox for an Eddy Current-Based Wearable Gait Training Robot.

Eddy current brakes have been recently used for functional resistance training in individuals with neurological and orthopaedic disorders. These devices consist of a gearbox, a conductive disc, and permanent magnets that can be moved relative to the disc to alter resistance. However, current devices use a commercial planetary gearbox with a tall profile that sticks out from the leg, which affects wearability.

Rest the Brain to Learn New Gait Patterns after Stroke.

Background: The ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these prior studies could have been confounded by the presence of significant motor impairments and/or have not focused on motor acuity tasks (i.

Applying elastic resistance bands for gait training: A simulation-based study to determine how band configuration affects gait biomechanics and muscle activation.

Background: Wearable robotic exoskeletons and leg braces are desirable for gait rehabilitation because they can apply loads directly to an affected joint. Yet, they are not widely used in clinics because they are costly and complex to set up. Conversely, tethered devices, such as elastic resistance bands, are widely available in clinics, are low-cost, and are quick to set up.

Combination therapy with simultaneous delivery of spinal cord stimulation modalities: COMBO randomized controlled trial.

The Combining Mechanisms for Better Outcomes randomized controlled trial assessed the effectiveness of various spinal cord stimulation (SCS) modalities for chronic pain. Specifically, combination therapy (simultaneous use of customized sub-perception field and paresthesia-based SCS) versus monotherapy (paresthesia-based SCS) was evaluated. Participants were prospectively enrolled (key inclusion criterion: chronic pain for ≥6 months).

Dynamic knee stiffness during walking is increased in individuals with anterior cruciate ligament reconstruction.

Individuals with anterior cruciate ligament (ACL) reconstruction often display abnormal gait mechanics reflective of a "stiff-knee" gait (i.e., reduced knee flexion angles and moments).

Comparing the accuracy of open-source pose estimation methods for measuring gait kinematics.

Background: Open-source pose estimation is rapidly reducing the costs associated with motion capture, as machine learning partially eliminates the need for specialized cameras and equipment. This technology could be particularly valuable for clinical gait analysis, which is often performed qualitatively due to the prohibitive cost and setup required for conventional, marker-based motion capture.

Research Question: How do open-source pose estimation software packages compare in their ability to measure kinematics and spatiotemporal gait parameters for gait analysis?

Methods: This analysis used an existing dataset that contained video and synchronous motion capture data from 32 able-bodied participants while walking.

Functional Resistance Training Differentially Alters Gait Kinetics After Anterior Cruciate Ligament Reconstruction: A Pilot Study.

Background: Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)-acutely alter gait kinetics in this population.

Functional resistance training methods for targeting patient-specific gait deficits: A review of devices and their effects on muscle activation, neural control, and gait mechanics.

Background: Injuries to the neuromusculoskeletal system often result in weakness and gait impairments. Functional resistance training during walking-where patients walk while a device increases loading on the leg-is an emerging approach to combat these symptoms. However, there are many methods that can be used to resist the patient, which may alter the biomechanics of the training.

The MOTION Study: A Randomized Controlled Trial with Objective Real-World Outcomes for Lumbar Spinal Stenosis Patients Treated with the mild® Procedure: One-Year Results.

Objective: The purpose of this study is to provide Level-1 objective, real-world outcome data for patients with lumbar spinal stenosis suffering from neurogenic claudication secondary to hypertrophic ligamentum flavum.

Design: The MOTION Study is a prospective, multicenter, randomized controlled trial comparing the mild® Procedure (minimally invasive lumbar decompression; Vertos Medical, Aliso Viejo, CA, USA) as a first-line therapy in combination with nonsurgical conventional medical management (CMM) vs CMM alone as the active control.

Methods: Patients in the test group received the mild Procedure at baseline.

Motor slacking during resisted treadmill walking: Can visual feedback of kinematics reduce this behavior?

Background: Functional resistance training is frequently applied to rehabilitate individuals with neuromusculoskeletal injuries. It is performed by applying resistance in conjunction with a task-specific training, such as walking. However, the benefits of this training may be limited by motor slacking, a phenomenon in which the human body attempts to reduce muscle activation levels or movement excursions to minimize metabolic- or movement-related costs.

Functional Resistance Training to Improve Knee Strength and Function After Acute Anterior Cruciate Ligament Reconstruction: A Case Study.

Background: Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, "nonfunctional" training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR.

Design and Preliminary Assessment of a Passive Elastic Leg Exoskeleton for Resistive Gait Rehabilitation.

Objective: This article aimed to develop a unique exoskeleton to provide different types of elastic resistances (i.e., resisting flexion, extension, or bidirectionally) to the leg muscles during walking.

Pain relief outcomes using an SCS device capable of delivering combination therapy with advanced waveforms and field shapes.

Background: Given the range of subjective experiences reported by patients with chronic pain, Spinal Cord Stimulation (SCS) systems designed for tailored delivery of analgesic therapy may help improve treatment effectiveness and satisfaction.

Research Design And Methods: This case-series evaluated 420 patients with chronic back and/or leg pain implanted with an SCS device capable of sequential or simultaneous delivery of neurostimulation (i.e.

Motor Modules are Impacted by the Number of Reaching Directions Included in the Analysis.

Muscle synergy analysis is commonly used to study how the nervous system coordinates the activation of a large number of muscles during human reaching. In synergy analysis, muscle activation data collected from various reaching directions are subjected to dimensionality reduction techniques to extract muscle synergies. Typically, muscle activation data are obtained only from a limited set of reaches with an inherent assumption that the performed reaches adequately represent all possible reaches.

Outcomes of a Multicenter, Prospective, Crossover, Randomized Controlled Trial Evaluating Subperception Spinal Cord Stimulation at ≤1.2 kHz in Previously Implanted Subjects.

Objective: The WHISPER randomized controlled trial (RCT) evaluates safety and clinical effectiveness of subperception spinal cord stimulation (SCS) at ≤1.2 kHz in subjects previously implanted with an SCS system for treatment of chronic, neuropathic pain.

Methods: WHISPER is a prospective, multicenter RCT with a crossover design sponsored by Boston Scientific, Marlborough, MA (ClinicalTrials.

Learning new gait patterns is enhanced by specificity of training rather than progression of task difficulty.

The use of motor learning strategies may enhance rehabilitation outcomes of individuals with neurological injuries (e.g., stroke or cerebral palsy).

Self-powered robots to reduce motor slacking during upper-extremity rehabilitation: a proof of concept study.

Background: Robotic rehabilitation is a highly promising approach to recover lost functions after stroke or other neurological disorders. Unfortunately, robotic rehabilitation currently suffers from "motor slacking", a phenomenon in which the human motor system reduces muscle activation levels and movement excursions, ostensibly to minimize metabolic- and movement-related costs. Consequently, the patient remains passive and is not fully engaged during therapy.

Long-Term Safety and Efficacy of Minimally Invasive Lumbar Decompression Procedure for the Treatment of Lumbar Spinal Stenosis With Neurogenic Claudication: 2-Year Results of MiDAS ENCORE.

Background And Objectives: This study evaluated the long-term durability of the minimally invasive lumbar decompression (MILD) procedure in terms of functional improvement and pain reduction for patients with lumbar spinal stenosis and neurogenic claudication due to hypertrophic ligamentum flavum. This is a report of 2-year follow-up for MILD study patients.

Methods: This prospective, multicenter, randomized controlled clinical study compared outcomes for 143 patients treated with MILD versus 131 treated with epidural steroid injections.