Search Results (71)

Background and Clinical Significance: Hemiplegia following a cerebrovascular accident (CVA) disrupts gait symmetry and efficiency, compromising functional independence. The integration of surface electromyography (sEMG) and inertial measurement units (IMU) enables quantitative assessment of muscle activation and segmental dynamics, providing objective data for therapeutic planning. Case presentation: A 57-year-old male with chronic right hemiplegia, eight years post-ischemic stroke of the left middle cerebral artery. The patient ambulated independently without assistive devices, exhibiting right lower-limb circumduction. Clinical assessment revealed the following scores: Barthel Index 85/100, Tinetti Performance-Oriented Mobility Assessment (POMA) 16/28, Timed Up and Go (TUG) test 13 s, and Modified Ashworth Scale (MAS) scores of 1 (upper limb) and 1+ (lower limb). Methods: Multichannel sEMG (Miotool 800^®, 8 channels) was recorded form the lumbar erectors, gluteus medius and maximus, vastus medialis, vastus intermedius, vastus lateralis, biceps femoris, tibialis anterior, medial gastrocnemius, and lateral gastrocnemius. Ag/AgCI electrodes were positioned according to SENIAM recommendations: sampling rate: 1000 Hz; band-pass filter: 20–500 Hz; notch filter: 60 Hz; normalization to %MVC. Simultaneously, IMU signals (Xsens DOT^®, 60 Hz) were collected from both ankles during slow, medium and fast walking (20 s each) and compared with a healthy control subject. Results: The patient exhibited reduced sEMG amplitude and increased peak irregularity on the affected side, particularly in the gluteus medius, tibialis anterior, and gastrocnemius, along with agonist desynchronication. IMU data revealed decreased range of motion and angular pattern irregularity, with inconsistent acceleration peaks in the right ankle compared to the control, confirming neuromuscular and kinematic asymmetry. Conclusions: The combined sEMG-IMU analysis identified deficits in selective motor control and propulsion on the affected hemibody, providing essential information to guide physiotherapeutic interventions targeting pelvic stability, dorsiflexion, and propulsive phase training, enabling objective follow-up beyond specialized laboratory settings. Full article

Background/Objectives: Cerebral palsy (CP) is a non-progressive, permanent syndrome of childhood, with approximately 80% of patients exhibiting spasticity. Untreated spasticity can cause pain, structural changes in bones, muscles, and nerves negatively impacting quality of life and functionality. Photobiomodulation (PBM) has demonstrated biological effects such as tissue regeneration, muscle relaxation, inflammation reduction, and pain relief. The objective of this pilot study is to evaluate the action of PBM on the spasticity of the medial and lateral right gastrocnemius muscles of children and adolescents with spastic cerebral palsy. Methods: This single-blinded, randomized, controlled trial evaluated PBM’s effect on gastrocnemius spasticity in children and adolescents with CP. The study presents pilot preliminary results from twelve children and adolescents (7–16 years) with spastic CP who were randomized into two groups: active PBM (850 nm, 100 mW, 1.5 J/point, 2 points, weekly for 8 weeks) or placebo (same protocol, device off). Both groups received standard rehabilitation exercises. Outcomes were assessed using the Modified Ashworth Scale (MAS), Pediatric Evaluation of Disability Inventory (PEDI), Gross Motor Function Classification System (GMFCS), and ankle range of motion before and after the intervention (8 weeks). Results: MAS and all outcomes improved significantly over time in both groups. No significant differences were found between groups for all outcomes. The PBM effect size on MAS improvement (ANOVA, Analysis of Vari, η² = 0.171) suggests modest but positive benefits. PBM did not worsen spasticity, and no adverse effects were reported. Conclusion: This study represents a pioneering effort in evaluating a safe PBM protocol for the spastics gastrocnemius in children and adolescents with CP. This protocol, used as an adjunct to physiotherapy, demonstrated no short-term adverse effects and no participant dropouts. Future studies should explore this PBM protocol in patients with less severe GMFCS levels, those with minimally preserved functionality, or those with contraindications to physiotherapeutic exercises. Full article

Background and Objectives: Spinal cord lesion is a severe disorder of the central nervous system, leading to partial or complete interruption of nerve impulse transmission between the brain and the periphery and causing severe neurological and functional deficits. Conventional rehabilitation offers limited outcomes, while robotic gait training (Lokomat^®) and Vojta Therapy have shown benefits individually. Evidence on their combined effect remains scarce. To evaluate the combined effect of Vojta Therapy and Lokomat-assisted gait training on motor recovery, functional independence, and quality of life in SCL patients. Materials and Methods: A retrospective clinical study was conducted on 205 patients with traumatic and non-traumatic SCL. Patients were allocated to four groups: (F)—conventional rehabilitation; (V)—conventional + Vojta; (L)—conventional + Lokomat; (VL)—conventional + Vojta + Lokomat. Assessments included the ASIA Impairment Scale (AIS), ASIA motor/sensory scores, spasticity (Modified Ashworth Scale, MAS), functional independence (Functional Independence Measure, FIM), and health-related quality of life (EQ-5D), performed at admission and discharge. Statistical analyses comprised paired t-tests, Wilcoxon signed-rank tests, chi-square tests, Kruskal–Wallis with Dunn’s post hoc corrections, and linear regression. Results: The most frequent lesion levels were C7 (21%) and L1 (20%). All groups showed improvement in FIM scores, with the greatest gains in the VL group (from 79.25 to 84.79, p < 0.05). Post hoc analysis confirmed significantly higher FIM outcomes in VL compared with L. Regression analysis identified the ASIA motor score as the strongest predictor of functional independence (β = 0.76, p < 0.001), with VL group membership adding +10.3 points (p = 0.004). EQ-5D indicated persistent deficits in mobility and self-care, especially in VL patients, consistent with higher lesion severity. Conclusions: Combining Vojta Therapy with Lokomat training provides additional functional benefits compared with Lokomat or Vojta alone. Multimodal individualized rehabilitation appears promising for patients with spinal cord lesions. Prospective randomized controlled trials with long-term follow-up are warranted. Full article

Rehabilitation of upper extremity (UE) impairments after stroke requires regular evaluation, with standard methods typically being time–consuming and relying heavily on manual assessment by therapists. In our study, we propose automating these assessments using electromyography (EMG) as a core indicator of muscle activity, correlating passive and active EMG signals with clinical motor impairment scores. UE motor function in 25 patients was evaluated using the Fugl–Meyer Assessment for UE (FMA–UE), the Modified Ashworth Scale (MAS), and the Brunnstrom Recovery Stages (BRS). EMG data were processed via feature extraction and linear discriminant analysis (LDA), with 10-fold cross–validation for binary classification based on clinical score thresholds. The LDA classifier accurately distinguished impairment categories, achieving area under the receiver operating characteristic curve (AUC–ROC) scores of 0.897 ± 0.272 for FMA–UE > 33, 0.981 ± 0.103 for FMA–UE > 44, 0.890 ± 0.262 for MAS > 0, 0.968 ± 0.130 for BRS > 3, and 0.987 ± 0.085 for BRS > 4. Notably, resting–state EMG alone yielded comparable classification performance. These findings demonstrate that EMG–driven assessments can reliably classify motor impairment levels, offering a pathway to objective clinical scoring that can streamline rehabilitation workflows, reduce therapists’ manual burden, and prioritize patient recovery over assessment procedures. Full article

Background/Objectives: Ankle plantar flexor spasticity after stroke may limit mobility, especially during turning and multi-directional stepping. Evidence on performance differences and measurement properties across spasticity levels is limited. We examined whether performance on the Activities-specific Balance Confidence Scale (ABC Scale), Five Times Sit-to-Stand Test (5xSTS), Figure-of-8 Walk Test (F8WT), and Four-Square Step Test (FSST) differs by spasticity severity, and evaluated test–retest reliability, the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the minimal detectable change (MDC). Methods: In an observational cross-sectional comparative study, 54 individuals more than 6 months post-stroke were classified into three groups by the Modified Ashworth Scale (MAS = 0, MAS = 1 − 1+, MAS ≥ 2). Participants completed the ABC Scale, 5xSTS, F8WT, and FSST. One-way analysis of variance with Bonferroni adjustment tested group differences. Reliability was quantified using ICC (2,1); SEM and MDC at the 95% confidence level indexed absolute reliability. Results: No significant differences were found for the ABC Scale or 5xSTS. F8WT and FSST differed by spasticity level (p < 0.05), with poorer performance in the highest-spasticity group versus no spasticity. ICCs were high across assessments. All SEMs were <20% of test–retest means, and all MDCs were <20% of maximum scores. Conclusion: Assessments that require directional change detected differences across spasticity levels, whereas balance confidence and repeated sit-to-stand did not. All measures showed acceptable relative and absolute reliability. Findings support selecting outcomes by spasticity severity and using SEM and MDC as reference values when interpreting change in stroke rehabilitation. Full article

Background and Objectives: Horse riding simulators (HRS) provide rhythmic, repetitive, and multidirectional movements analogous to horseback riding, which may facilitate postural control, balance, and functional abilities in children with cerebral palsy (CP). This study aimed to investigate the effects of the HRS application on the muscle tone of the lower extremity, gross motor function, trunk postural control, balance, gait functions, and functional independence in children with CP. Materials and Methods: A quasi-experimental study included 30 children with cerebral palsy (17 hemiparetic, 13 diparetic; mean age, 9.3 ± 3.2 years). All participants received Neurodevelopmental Therapy (NDT) for eight weeks, followed by eight weeks of HRS plus NDT, in a sequential design. Outcomes included the Modified Ashworth Scale (MAS), Myoton^®PRO, Gross Motor Function Measures (GMFM)-88, Pedalo^® Sensamove Balance Test (Pedalo^® SBT), Pediatric Balance Scale (PBS), Trunk Impairment Scale (TIS), gait analysis parameters, and Functional Independence Measure (WeeFIM). Assessments were made at baseline, the 8th, and the 16th week. Results: At week 16, after incorporating HRS, all MAS parameters demonstrated greater improvements compared to those achieved during the first eight weeks of NDT alone (ES: 0.728–0.931, p < 0.05). Myoton^®PRO measurements showed a significant reduction in gastrocnemius stiffness (ES = 0.672, p < 0.05) in hemiparetic children and decreases in hip adductor (ES: 0.649, p < 0.05) and gastrocnemius-soleus (ES: 0.766–0.865, p < 0.05) stiffness from week 8 to 16 in diparetic children following HRS intervention. Total scores on the GMFM-88, WeeFIM, TIS, and PBS improved significantly, with large effect sizes observed both from baseline to week 16 and from week 8 to 16 (ES: 0.771–0.886, p < 0.05). Additionally, Pedalo^® SBT scores increased following HRS intervention from baseline to week 16 (ES = 0.599–0.602, p < 0.05). Conclusions: HRS integrated with conventional NDT may improve muscle tone, motor function, balance, gait, and functional independence in children with cerebral palsy, representing a valuable adjunct to standard rehabilitation. These findings provide the first evidence that simulator-assisted interventions may benefit daily activities in children with cerebral palsy. Full article

Background/Objectives: Standing training is essential for individuals with spinal cord injury (SCI), yet maintaining regular practice after acute rehabilitation remains challenging. To address the need for more practical and accessible standing equipment, we developed a novel spring-assisted standing training device designed to overcome barriers to regular standing practice. This study aimed to assess the safety and feasibility of our newly developed device in individuals with SCI. Methods: Six participants with chronic SCI (neurological level of injury T4-L3, American Spinal Injury Association Impairment Scale A-C; 2 females, mean age 41.7 ± 13.4 years) underwent a single session using our chair-based device incorporating passive gas spring mechanisms. We designed this device to enable independent sit-to-stand transitions without electrical power or complex controls. Primary outcomes included safety (adverse events) and feasibility (number of repetitions, Modified Borg Scale). Changes in Modified Ashworth Scale (MAS) scores were assessed as exploratory measures. Results: All participants successfully completed training without adverse events. Repetitions ranged from 5 to 60 (median 37), with Modified Borg Scale ratings of 0–4. Notably, the participant with T4 complete injury performed the training without requiring trunk orthosis, demonstrating the device’s inherent stability. MAS sum scores showed a reduction from median 8.75 to 4.25, though this did not reach statistical significance (p = 0.13). Conclusions: Our newly developed spring-assisted standing training device proved safe and feasible for individuals with SCI, including those with complete thoracic injuries. The device successfully enabled independent sit-to-stand transitions with low perceived exertion, potentially addressing key barriers to regular standing practice and offering a practical rehabilitation solution. Full article

Objective: Neurosurgical interventions for medically refractory hypertonia (MRH) benefit both patients and their caregivers. Concurrent severe rotatory scoliosis and fusion constructs can make traditional microsurgical rhizotomy and navigated radiofrequency ablation (RFA) peripheral rhizotomy technically infeasible. We report the first case series of lumbosacral endoscopic ventral–dorsal rhizotomy (eVDR) in patients with MRH, and highlight this novel, minimally invasive, safe, and effective technique. Material and Methods: We retrospectively reviewed our single institution series of four patients with advanced hypertonia, gross motor function classification scale (GMFCS) 5, and severe rotatory scoliosis who underwent an eVDR using a flexible endoscope. We report demographics, operative characteristics, and outcomes. Results: Four patients underwent bilateral L1-S1 eVDR. Two patients had spastic quadriplegia and two had mixed spastic and dystonic hypertonia. Mean operative time was 225 ± 11 min and mean estimated blood loss (EBL) was 28.8 ± 26.2 mLs. Average length of stay was 2.75 days (range = 1–5 days), and average follow-up was 5.75 months (range = 3–9 months). All patients had significant decrease in bilateral lower extremity modified Ashworth Scale (mAS) scores (median decrease = 3, interquartile range [IQR] = 1; Wilcoxon rank-sum test z = −2.3, p = 0.02). The median decrease in Barry–Albright Dystonia Scale (BADS) scores for both patients with dystonia was 8 (IQR = 0). Two patients had minor perioperative events; none required additional surgery. All parents reported improvement in caregiving metrics. Conclusions: eVDR offers a safe and effective approach for tone reduction in patients with MRH and severe rotatory scoliosis and/or fusion hardware, which disallows traditional approaches. Full article

Background: Aquatic therapy (AT), immersion in hot water, and supported standing are frequently used to manage spasticity, contractures, and joint retractions in children with cerebral palsy (CP). Recently, the use of exoskeletons has been offering a new treatment option for severe CP. This study aimed to compare the post-immediate effects of four treatments on spasticity, range of motion, and the heart rate of children with severe CP. Methods: Three children with spastic CP (levels IV and V GMFCS) received a single 30-min session in consecutive weeks of robot-assisted gait training (RAGT), AT, supported standing, and immersion in hot water. Post-immediate assessments included knee flexor spasticity (modified Ashworth scale, MAS, and modified Tardieu scale, MTS); knee range of motion (ROM, in degrees (°)); and heart rate (HR). Results: AT and supported standing induced greater reductions in spasticity based on MAS scores. RAGT demonstrated superior spasticity reduction using MTS and yielded the greatest improvement in popliteal angle (mean increase: 27°). AT and RAGT induced a 14 beats-per-minute change in HR, indicating moderate cardiovascular engagement. Conclusions: RAGT appears particularly effective in improving spasticity and ROM in children with severe CP. Nonetheless, conventional treatments still offer an effective option when addressing spasticity. Full article

Background/Objectives: Spasticity in children with cerebral palsy (CP) can impair motor-related functions. The objective of this exploratory, prospective study was to examine if transcutaneous electrical nerve stimulation (TENS) in a whole-body suit leads to changes in spasticity and other related effects. Methods: Thirty-one children with CP GMFCS III–V, with a median age of 11.0 years (age range of 7–17 years), were consecutively included, and they used the suit with TENS for 24 weeks. The primary outcome was spasticity measured using the Modified Ashworth Scale (MAS). Functional motor-related tasks were evaluated by the Goal Attainment Scale (SMART GAS). The Modified Tardieu Scale (MTS), passive Range of Motion (pROM), GMFM-66, and Posture and Postural Ability Scale (PPAS) assessments were performed. Results: Seventeen subjects (17/31) completed the 24 weeks. Dropout was due to difficulty in donning the suit. The level of overall spasticity, most pronounced in the proximal arms and legs, was reduced according to the MAS, but not the MTS or pROM. Subject-relevant motor-related goals improved significantly in standing/walking and hand/arm function. Changes in the GMFM-66 and PPAS were not significant. Conclusions: Although there were statistically significant but underpowered changes in the MAS after 24 weeks, there were no clinically relevant effects. Exploratorily, we found observer-reliant motor-related functional improvements, which, however, we were unable to detect when trying to quantify them. Donning the suit led to dropout throughout the study. Caregivers need to allocate time, mental capacity and have the physical skill set for donning the suit for long-term use. Full article

Upper-limb impairments after stroke significantly affect patients’ quality of life and require effective rehabilitation strategies. Rehabilitation devices play a vital role in enhancing motor recovery. This study evaluated the efficacy of the Arm Booster, a bilateral arm-training device, in improving upper-limb impairment in patients with chronic stroke. Eighteen participants were randomly assigned to two groups: a device group (n = 9), using the Arm Booster; and a conventional physiotherapy group (n = 9). Both groups performed six bilateral upper-limb exercises (32 repetitions each) three times per week for eight weeks. Participants were further classified into mild spasticity (n = 5) and moderate-to-severe spasticity (n = 4) subgroups. The primary outcome was motor impairment, assessed using the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE). Secondary outcomes included spasticity, measured by the Modified Ashworth Scale (MAS), and daily functional use of the arm, assessed with the Motor Activity Log (MAL). Both groups showed significant improvements in FMA-UE scores and overall arm movement. The conventional group demonstrated additional gains in hand and wrist function and coordination. Notably, in the moderate-to-severe spasticity subgroup, the device group exhibited improvements in upper-limb movement and a trend toward reduced spasticity. These findings suggest that the Arm Booster may support motor recovery, encourage the use of the affected arm, improve movement control, and provide an efficient means for patients to exercise more frequently on their own. Full article

Background: Spasticity, a hallmark of quadriplegic cerebral palsy (CP), severely impacts mobility and quality of life. While exercise is known to enhance fitness and motor function in individuals with CP, its specific efficacy in reducing upper extremity spasticity remains insufficiently studied. This research investigated the effects of weight-resistance exercise (RE), hand cycle bike exercise (BE), and aquatic exercise (AE) on upper extremity spasticity in an adult with quadriplegic CP. Method: The participant was a 35-year-old individual with quadriplegic spastic CP, presenting severe spasticity in the right upper extremity and lower limbs, and milder left arm involvement. Dependent on a power wheelchair, they were cognitively intact, college-educated, and had participated in a community exercise program for five years. Over nine weeks, the participant completed 18 sessions—6 per modality of RE, BE, and AE—with each session held twice weekly for 50 min. Spasticity was assessed using the Modified Ashworth Scale (MAS) before and after sessions, with comprehensive pre- and post-intervention evaluations. Result: Total MAS scores decreased significantly from 2.76 to 2.33 (p < 0.05). AE yielded the largest reduction (2.81 to 2.10), followed by BE (2.75 to 2.36) and RE (2.72 to 2.54). ANOVA confirmed AE’s superior efficacy (F(2,15) = 27.20, p < 0.001, ηp² = 0.78), with a 0.33 reduction overall. Conclusions: AE was most effective, likely due to buoyancy, followed by BE, with RE showing the least impact. These findings highlight aquatic interventions as promising for spasticity management in CP, necessitating further longitudinal, multi-participant research. Full article

Background/Objectives: Functional electrical stimulation (FES) has been used to improve the quality of life of patients with stroke. Rehabilitation programs focus on standing and walking, which are vital to functional independence and keystone ingredients in functional competency. To examine the effects of simultaneous continuous ongoing FES of gluteus medius (GMed) and tibialis anterior (TA) muscles at isometric contraction during standing and walking in patients with stroke. Methods: Short- and long-term FES management programs of GMed and TA muscles during different conditions have been used in patients with stroke. FES was applied to hip abductors and dorsiflexor muscles of the affected limb during four different conditions: passive hip abduction and ankle dorsiflexion, respectively (condition 1), sit-to-stand (condition 2), 10 m walk test (condition 3), and walking on C-mill treadmill (condition 4). The Modified Ashworth Scale (MAS), Five Times sit-to-stand test (FTSST), 10-m walk test (10-MWT), and C-mill treadmill were used to assess spasticity in the hip adductor and calf muscles, sit-to-stand performance, and temporal–spatial characteristics, respectively. Results: Short- and long-term FES management programs significantly reduced spasticity in the hip adductor and calf muscles and improved sit-to-stand performance, gait speed, and gait temporal–spatial characteristics. Conclusions: Short- and long-term FES management programs of GMed and TA muscles can quickly and effectively improve the spasticity and ambulation of patients with stroke. Further research incorporating gait analysis with randomized controlled samples is needed. Full article

Introduction: Multiple Sclerosis (MS) is associated with a wide range of debilitating symptoms, and conventional therapies often fail to adequately address the disease’s multifaceted challenges. Cannabidiol (CBD) 13.0% + Delta9-tetrahydrocannabinol (THC) 9.0% (CBD13/THC9), a vaporized cannabis-based medicinal product, presents a novel therapeutic option for managing MS symptoms. Methods: This single-center longitudinal study followed 69 MS patients over a six-month period. Participants were assessed at treatment initiation and at three- and six-month intervals. Key measures included muscle spasticity, urine bladder dysfunction, and the evaluation of disability progression rate. The evaluation included the Modified Ashworth Scale (MAS), the Post Void Residual (PVR) volume, and the Expanded Disability Status Scale (EDSS). Results: Significant improvement was observed across all outcome assessments. The EDSS score was decreased over time (p = 0.009), indicating a slight reduction in disability progression rate, while MAS scores showed substantial improvement in muscle spasticity (p < 0.001). Urine bladder function improved significantly, with PVR volume showing notable improvement between baseline and the six-month assessment (p < 0.001). Correlation analyses revealed that a gradual increase in vaporized CBD13/THC9 dose was correlated with slightly lower EDSS scores, while the adverse effects were negatively associated with the frequency of cannabinoid use. Finally, patients who were smokers used CBD13/THC9 more frequently. Conclusions: The vaporized CBD13/THC9 formulation demonstrated notable efficacy in slightly improving disability progression rate via reduction in muscle spasticity and urine bladder dysfunction in MS patients. This highlights its addon therapeutic value during rehabilitation in MS patients with debilitating disability symptoms. Full article

Introduction: Post-stroke spasticity (PSS) significantly impacts the quality of life for stroke survivors. While various treatments exist, options for refractory cases are limited. Ultrasound-guided percutaneous peripheral nerve stimulation (pPNS), commonly used in pain management, has not been studied for its potential use in spasticity management. This case report aims to evaluate the sensorimotor effects of pPNS in a patient with severe PSS. Case description: A 38-year-old male with severe PSS and functional limitations post-ischemic stroke in the middle cerebral artery underwent a six-week pPNS protocol (12 sessions). Low-frequency (2 Hz) stimulation targeted the median, musculocutaneous, and anterior interosseous nerves, while medium-frequency (10 Hz) stimulation targeted the posterior interosseous and radial nerves. Spasticity was assessed using the Modified Ashworth Scale (MAS) and Tardieu Scale (TS). Somatosensory assessments included tactile thresholds, pressure pain thresholds, and conditioned pain modulation (CPM). Outcomes: Spasticity decreased significantly, with reductions of 60.4% and 67.0% in elbow and wrist MAS scores, respectively, and a 49.5% reduction in TS scores. However, spasticity levels returned to baseline between sessions. Somatosensory assessments revealed increased tactile thresholds, decreased pressure pain thresholds, and an 81.3% reduction in CPM. The intervention was well tolerated, with minor transient effects, and the patient preferred pPNS over botulinum toxin injections. Conclusions: pPNS may effectively reduce spasticity and modulate somatosensory thresholds in PSS. These preliminary findings highlight its potential as an alternative treatment for refractory PSS, warranting further research with larger sample sizes and control groups to assess its broader clinical applicability. Full article