BioMed Research International: Rehabilitation The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Comparison of High-Intensity Laser Therapy and Ultrasound Treatment in the Patients with Lumbar Discopathy Wed, 25 Mar 2015 08:40:49 +0000 The aim of the present study was to evaluate the efficiency of high intensity laser and ultrasound therapy in patients who were diagnosed with lumbar disc herniation and who were capable of performing physical exercises. 65 patients diagnosed with lumbar disc were included in the study. The patients were randomly divided into three groups: Group 1 received 10 sessions of high intensity laser to the lumbar region, Group 2 received 10 sessions of ultrasound, and Group 3 received medical therapy for 10 days and isometric lumbar exercises. The efficacy of the treatment modalities was compared with the assessment of the patients before the therapy at the end of the therapy, and in third month after the therapy. Comparing the changes between groups, statically significant difference was observed in MH (mental health) parameter before treatment between Groups 1 and 2 and in MH parameter and VAS score in third month of the therapy between Groups 2 and 3. However, the evaluation of the patients after ten days of treatment did not show significant differences between the groups compared to baseline values. We found that HILT, ultrasound, and exercise were efficient therapies for lumbar discopathy but HILT and ultrasound had longer effect on some parameters. Ismail Boyraz, Ahmet Yildiz, Bunyamin Koc, and Hakan Sarman Copyright © 2015 Ismail Boyraz et al. All rights reserved. Plantar Loading Reflects Ulceration Risks of Diabetic Foot with Toe Deformation Mon, 16 Mar 2015 11:11:46 +0000 Diabetes has been one of the most common chronic diseases all over the world. The purpose of this study was to quantitatively assess the foot loading characteristics of diabetic patients with fifth-toe deformity through a comparative analysis with diabetic patients with healthy and normal feet. Six neuropathic diabetic female subjects with the fifth-toe deformation and six age-matched neuropathic diabetic controls without any feet deformities participated in the walking test. Dynamic barefoot plantar pressure was measured with Novel EMED force plate. Peak pressure and pressure-time integral for all 7 foot regions (rearfoot, midfoot, lateral forefoot, central forefoot, medial forefoot, great toe, and other toes) were collected. Peak pressure was significantly higher in the patients with toe deformity in rearfoot, central forefoot, and great toe regions compared with the control group. Meanwhile, loading sustaining period extended longer in great toe region of deformed group than in that of the control group, and the center of pressure was nearly in the big toe region during toe offstage. Diabetic patients with fifth-toe deformity could have plantar contact area reduction in the other toes part and increased loading to the great toe part. The result showed that fifth-toe deformity was associated with potential ulceration risk especially in hallux region. Y. C. Lu, Q. C. Mei, and Y. D. Gu Copyright © 2015 Y. C. Lu et al. All rights reserved. Cognitive-Motor Interference in Multiple Sclerosis: A Systematic Review of Evidence, Correlates, and Consequences Mon, 09 Mar 2015 12:58:53 +0000 Individuals with multiple sclerosis (MS) regularly exhibit deficits in motor and cognitive function. Recent evidence suggests that these impairments are compounded when motor and cognitive task are performed simultaneously such as walking while talking. The changes incurred during simultaneous performance of motor and cognitive tasks are a result of cognitive-motor interference (CMI) and operationalized as dual task costs (DTC). Recently in MS, research has been conducted to understand and analyze the impact of CMI. The purpose of this paper was to review the current literature related to the evidence, correlates, and consequences of CMI in MS. Relevant literature was collected from the results of a PubMed search for terms including “Cognitive-motor interference” or “Cognitive-motor interaction” or “Dual task” and “multiple sclerosis.” Overall, 20 papers were included for review which focused on CMI during balance and walking tasks. The finding that there is a lack of evidence pertaining to changes in the cognitive domain as well as to the specific consequences of CMI in MS was noted. Future work should aim to fill these gaps and ultimately investigate the usefulness of targeted interventions in reducing the deleterious effects of CMI in individuals with MS. Douglas A. Wajda and Jacob J. Sosnoff Copyright © 2015 Douglas A. Wajda and Jacob J. Sosnoff. All rights reserved. Technological Advances in Instrumental Assessment in Rehabilitation Thu, 05 Mar 2015 07:42:50 +0000 Giorgio Ferriero, Stefano Carda, Sasa Moslavac, and Alessia Rabini Copyright © 2015 Giorgio Ferriero et al. All rights reserved. Thermal Tomography Imaging in Photonic Traditional Chinese Medicine Information Therapy with Holistic Effect for Health Whole Nursing Tue, 03 Mar 2015 11:49:32 +0000 A photonic traditional Chinese medicine (TCM) information therapy was developed that has applications in whole health nursing including the prevention and treatment of ischemic cardiovascular and cerebrovascular diseases as well as the conditioning of the subhealth state. This therapy utilizes the beam of a 630 nm LED light to irradiate the oropharynx, while simultaneously employing two beams of 650 nm LED light to irradiate corresponding acupuncture points resulting in a synergistic outcome. This method was named “1 + 2 phototherapy.” The principle mechanism of the therapy is a series of photon induced biological effects that are triggered by stimulating the photosensitive tissues of the oropharynx. This tissue includes the oral mucosa, capillaries, lymph nodes, saliva glands, nerves, and Jingluo and is stimulated by light beams of certain photon energy and imitative acupuncture information. Thermal tomography imaging shows that the average temperature of the upper-body was improved significantly after oropharyngeal irradiation under irradiation of “Futu point”: the heat radiation of the spine, as well as chest, shoulders, arms, and clavicle, increased under irradiation of “Hoku,” whereas the overall average temperature was below the temperature before irradiation. The experiment indicates that this therapy can promote blood circulation, regulate varied physiological parameters, and have holistic effects in whole health nursing. Binggang Ye, Zhouyi Guo, Hanchuan Huang, and Xicheng Yang Copyright © 2015 Binggang Ye et al. All rights reserved. Ankylosing Spondylitis and Posture Control: The Role of Visual Input Tue, 03 Mar 2015 06:24:22 +0000 Objectives. To assess the motor control during quiet stance in patients with established ankylosing spondylitis (AS) and to evaluate the effect of visual input on the maintenance of a quiet posture. Methods. 12 male AS patients (mean age 50.1 ± 13.2 years) and 12 matched healthy subjects performed 2 sessions of 3 trials in quiet stance, with eyes open (EO) and with eyes closed (EC) on a baropodometric platform. The oscillation of the centre of feet pressure (CoP) was acquired. Indices of stability and balance control were assessed by the sway path (SP) of the CoP, the frequency bandwidth (FB1) that includes the 80% of the area under the amplitude spectrum, the mean amplitude of the peaks (MP) of the sway density curve (SDC), and the mean distance (MD) between 2 peaks of the SDC. Results. In severe AS patients, the MD between two peaks of the SDC and the SP of the center of feet pressure were significantly higher than controls during both EO and EC conditions. The MP was significantly reduced just on EC. Conclusions. Ankylosing spondylitis exerts negative effect on postural stability, not compensable by visual inputs. Our findings may be useful in the rehabilitative management of the increased risk of falling in AS. Alessandro Marco De Nunzio, Salvatore Iervolino, Carmela Zincarelli, Luisa Di Gioia, Giuseppe Rengo, Vincenzo Multari, Rosario Peluso, Matteo Nicola Dario Di Minno, and Nicola Pappone Copyright © 2015 Alessandro Marco De Nunzio et al. All rights reserved. Use of a Robotic Device for the Rehabilitation of Severe Upper Limb Paresis in Subacute Stroke: Exploration of Patient/Robot Interactions and the Motor Recovery Process Mon, 02 Mar 2015 11:22:03 +0000 This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age years; time since stroke, days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8 , while Guidance decreased at S12 . Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, ). Changes in FMA score were correlated with the Stiffness parameter (, ). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process. Christophe Duret, Ophélie Courtial, Anne-Gaëlle Grosmaire, and Emilie Hutin Copyright © 2015 Christophe Duret et al. All rights reserved. A Game System for Cognitive Rehabilitation Sun, 01 Mar 2015 14:06:41 +0000 Brain injury such as traumatic brain injury (TBI) and stroke is the major cause of long-term disabilities in many countries. The increasing rate of brain damaged victims and the heterogeneity of impairments decrease rehabilitation effectiveness and competence resulting in higher cost of rehabilitation treatment. On the other hand, traditional rehabilitation exercises are boring, thus leading patients to neglect the prescribed exercises required for recovery. Therefore, we propose game-based approach to address these problems. This paper presents a rehabilitation gaming system (RGS) for cognitive rehabilitation. The RGS is developed based on a proposed conceptual framework which has also been presented in this paper. Azrulhizam Shapi’i, Nor Azan Mat Zin, and Ahmed Mohammed Elaklouk Copyright © 2015 Azrulhizam Shapi’i et al. All rights reserved. Trigger Points: An Anatomical Substratum Tue, 24 Feb 2015 10:00:39 +0000 This study aimed to bring the trapezius muscle knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTrPs). Although anatomoclinical correlations represent a major feature of MTrP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTrP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Seven points are described, four of which are motor points: in all cases, these locations corresponded to clinically described MTrPs. The four points were common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MTrP is useful to achieve a better understanding of the anatomical correlation of MTrP and the physiopathology of these disorders and may provide a scientific basis for their treatment, rendering useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches. Flávia Emi Akamatsu, Bernardo Rodrigues Ayres, Samir Omar Saleh, Flávio Hojaij, Mauro Andrade, Wu Tu Hsing, and Alfredo Luiz Jacomo Copyright © 2015 Flávia Emi Akamatsu et al. All rights reserved. Evaluation of Pediatric Manual Wheelchair Mobility Using Advanced Biomechanical Methods Mon, 23 Feb 2015 08:24:34 +0000 There is minimal research of upper extremity joint dynamics during pediatric wheelchair mobility despite the large number of children using manual wheelchairs. Special concern arises with the pediatric population, particularly in regard to the longer duration of wheelchair use, joint integrity, participation and community integration, and transitional care into adulthood. This study seeks to provide evaluation methods for characterizing the biomechanics of wheelchair use by children with spinal cord injury (SCI). Twelve subjects with SCI underwent motion analysis while they propelled their wheelchair at a self-selected speed and propulsion pattern. Upper extremity joint kinematics, forces, and moments were computed using inverse dynamics methods with our custom model. The glenohumeral joint displayed the largest average range of motion (ROM) at 47.1° in the sagittal plane and the largest average superiorly and anteriorly directed joint forces of 6.1% BW and 6.5% BW, respectively. The largest joint moments were 1.4% body weight times height (BW × H) of elbow flexion and 1.2% BW × H of glenohumeral joint extension. Pediatric manual wheelchair users demonstrating these high joint demands may be at risk for pain and upper limb injuries. These evaluation methods may be a useful tool for clinicians and therapists for pediatric wheelchair prescription and training. Brooke A. Slavens, Alyssa J. Schnorenberg, Christine M. Aurit, Adam Graf, Joseph J. Krzak, Kathryn Reiners, Lawrence C. Vogel, and Gerald F. Harris Copyright © 2015 Brooke A. Slavens et al. All rights reserved. Design and User Evaluation of a Wheelchair Mounted Robotic Assisted Transfer Device Sun, 22 Feb 2015 11:35:33 +0000 Purpose. The aim of this study is to describe the robotic assisted transfer device (RATD) and an initial focus group evaluation by end users. The purpose of the device is to aid in the transfers of people with disabilities to and from their electric powered wheelchair (EPW) onto other surfaces. The device can be used for both stand-pivot transfers and fully dependent transfers, where the person being transferred is in a sling and weight is fully on the robot. The RATD is fixed to an EPW to allow for its use in community settings. Method. A functional prototype of the RATD was designed and fabricated. The prototype was presented to a group of 16 end users and feedback on the device was obtained via a survey and group discussion. Results. Thirteen out of sixteen (83%) participants agreed that it was important to develop this type of technology. They also indicated that user, caregiver, and robotic controls were important features to be included in the device. Conclusions. Participants in this study suggested that they would be accepting the use of robotic technology for transfers and a majority did not feel that they would be embarrassed to use this technology. Garrett G. Grindle, Hongwu Wang, Hervens Jeannis, Emily Teodorski, and Rory A. Cooper Copyright © 2015 Garrett G. Grindle et al. All rights reserved. Trunk and Shoulder Kinematic and Kinetic and Electromyographic Adaptations to Slope Increase during Motorized Treadmill Propulsion among Manual Wheelchair Users with a Spinal Cord Injury Sun, 22 Feb 2015 07:22:32 +0000 The main objective was to quantify the effects of five different slopes on trunk and shoulder kinematics as well as shoulder kinetic and muscular demands during manual wheelchair (MWC) propulsion on a motorized treadmill. Eighteen participants with spinal cord injury propelled their MWC at a self-selected constant speed on a motorized treadmill set at different slopes (0°, 2.7°, 3.6°, 4.8°, and 7.1°). Trunk and upper limb movements were recorded with a motion analysis system. Net shoulder joint moments were computed with the forces applied to the handrims measured with an instrumented wheel. To quantify muscular demand, the electromyographic activity (EMG) of the pectoralis major (clavicular and sternal portions) and deltoid (anterior and posterior fibers) was recorded during the experimental tasks and normalized against maximum EMG values obtained during static contractions. Overall, forward trunk flexion and shoulder flexion increased as the slope became steeper, whereas shoulder flexion, adduction, and internal rotation moments along with the muscular demand also increased as the slope became steeper. The results confirm that forward trunk flexion and shoulder flexion movement amplitudes, along with shoulder mechanical and muscular demands, generally increase when the slope of the treadmill increases despite some similarities between the 2.7° to 3.6° and 3.6° to 4.8° slope increments. Dany Gagnon, Annie-Claude Babineau, Audrey Champagne, Guillaume Desroches, and Rachid Aissaoui Copyright © 2015 Dany Gagnon et al. All rights reserved. Effectiveness of Hyaluronic Acid Administration in Treating Adhesive Capsulitis of the Shoulder: A Systematic Review of Randomized Controlled Trials Sat, 31 Jan 2015 16:07:37 +0000 Introduction. Adhesive capsulitis (AC) of the shoulder presents with an insidious onset of pain and progressive limitation of shoulder movement. Objectives. To investigate whether intra-articular hyaluronic acid (HA) administration alone is superior to conventional therapies and whether the addition of intra-articular HA administration to conventional therapies improves clinical outcomes in patients with AC. Methods. The PubMed, EMBASE, CINAHL, and Cochrane Library electronic databases were searched without language restrictions in July 2014 with a priori defined inclusion and exclusion criteria. Results. Four randomized controlled trials (273 participants, 278 shoulders) were included in this review. Two trials compared intra-articular HA administration with conventional therapies and 2 trials evaluated intra-articular HA administration as an addition to conventional therapies. Pain and shoulder function/disability outcomes in the HA injection group were not superior to those achieved in the conventional therapy groups. No significant differences in pain or shoulder function/disability outcomes were noted between the groups with and without adjunctive HA administration. Conclusions. Intra-articular HA administration alone is not superior to conventional AC treatments, and the addition of intra-articular HA administration to conventional therapies does not provide significant added benefits. HA administration in AC patients who are receiving conventional therapies should be evaluated to avoid unnecessary medical expenditure. Lin-Chien Lee, Fu-Kong Lieu, Hung-Lin Lee, and Tao-Hsin Tung Copyright © 2015 Lin-Chien Lee et al. All rights reserved. Effectiveness of Functional Electrical Stimulation in Improving Clinical Outcomes in the Upper Arm following Stroke: A Systematic Review and Meta-Analysis Thu, 22 Jan 2015 12:36:11 +0000 Background. Different therapeutic methods are being used to prevent or decrease long-term impairments of the upper arm in stroke patients. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of the weakened muscles so that the resulting muscle contractions resemble those of a functional task. Objectives. The objective of this study was to review the evidence for the effect of FES on (1) shoulder subluxation, (2) pain, and (3) upper arm motor function in stroke patients, when added to conventional therapy. Methods. From the 727 retrieved articles, 10 (9 RCTs, 1 quasi-RCT) were selected for final analysis and were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett’s levels of evidence. A meta-analysis was performed for all three considered outcomes. Results. The results of the meta-analyses showed a significant difference in shoulder subluxation in experimental groups compared to control groups, only if FES was applied early after stroke. No effects were found on pain or motor function outcomes. Conclusion. FES can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke. Amir K. Vafadar, Julie N. Côté, and Philippe S. Archambault Copyright © 2015 Amir K. Vafadar et al. All rights reserved. Neural and Nonneural Contributions to Wrist Rigidity in Parkinson’s Disease: An Explorative Study Using the NeuroFlexor Thu, 22 Jan 2015 12:29:42 +0000 Objective. The NeuroFlexor is a novel method incorporating a biomechanical model for the measurement of neural and nonneural contributions to resistance induced by passive stretch. In this study, we used the NeuroFlexor method to explore components of passive movement resistance in the wrist and finger muscles in subjects with Parkinson’s disease (PD). Methods. A cross-sectional comparison was performed in twenty-five subjects with PD with clinically identified rigidity and 14 controls. Neural (NC), elastic (EC), and viscous (VC) components of the resistance to passive extension of the wrist were calculated using the NeuroFlexor. Measurements were repeated during a contralateral activation maneuver. Results. PD subjects showed greater total resistance and NC compared to controls. EC and VC did not differ significantly between groups. Contralateral activation maneuver resulted in increased NC in the PD group but this increase was due to increased resting tension. Total resistance and NC correlated with clinical ratings of rigidity and with bradykinesia. Conclusions. The findings suggest that stretch induced reflex activity, but not nonneural resistance, is the major contributor to rigidity in wrist muscles in PD. The NeuroFlexor is a potentially valuable clinical and research tool for quantification of rigidity. H. Zetterberg, G. E. Frykberg, J. Gäverth, and P. G. Lindberg Copyright © 2015 H. Zetterberg et al. All rights reserved. Effects of Calcium Phosphate Nanocrystals on Osseointegration of Titanium Implant in Irradiated Bone Thu, 22 Jan 2015 12:19:25 +0000 Radiotherapy may compromise the integration of implant and cause implant loss. Implant surface modifications have the possibility of promoting cell attachment, cell growth, and bone formation which ultimately enhance the osseointegration process. The present study aimed to investigate the effects of calcium phosphate nanocrystals on implant osseointegration in irradiated bone. Sixteen rabbits were randomly assigned into control and nano-CaP groups, receiving implants with dual acid-etched surface or dual acid-etched surface discretely deposited of nanoscale calcium-phosphate crystals, respectively. The left leg of all the rabbits received 15 Gy radiation, followed by implants placement one week after. Four animals in each group were sacrificed after 4 and 12 weeks, respectively. Implant stability quotient (ISQ), ratio of bone volume to total volume (BV/TV), bone growth rate, and bone-to-implant contact (BIC) were evaluated. The nano-CaP group showed significantly higher ISQ (week 12, ) and bone growth rate (week 6, ; week 9, ) than that in control group. No significant differences in BV/TV and BIC were found between two groups. Titanium implant surface modified with CaP nanocrystals provides a potential alternative to improve bone healing around implant in irradiated bone. Jun Yuan Li, Edmond Ho Nang Pow, Li Wu Zheng, Li Ma, Dora Lai Wan Kwong, and Lim Kwong Cheung Copyright © 2015 Jun Yuan Li et al. All rights reserved. Neural Computation for Rehabilitation Sun, 28 Dec 2014 07:29:14 +0000 Xiaoling Hu, Yiwen Wang, Ting Zhao, and Aysegul Gunduz Copyright © 2014 Xiaoling Hu et al. All rights reserved. Sequential Coordination between Lingual and Pharyngeal Pressures Produced during Dry Swallowing Thu, 18 Dec 2014 00:11:21 +0000 The aim of this study was to investigate oropharyngeal pressure flow dynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP. There was no significant difference between the offset of TP and PP. The onset of PP was temporally time-locked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing. Jitsuro Yano, Yoichiro Aoyagi, Takahiro Ono, Kazuhiro Hori, Wakami Yamaguchi, Shigehiro Fujiwara, Isami Kumakura, Shogo Minagi, and Akio Tsubahara Copyright © 2014 Jitsuro Yano et al. All rights reserved. The Effects of Cryotherapy on Proprioception System Wed, 12 Nov 2014 00:00:00 +0000 Proprioception plays an important role in the complex mechanism of joint control. Contemporary sport activities impose extremely high physical demands on athletes. Winter sports are played in areas with excessively low temperatures. Moreover, many athletes are subjected to treatments that involve local lowering of the body temperature before, during, and after physical activity. This work reviews the current knowledge regarding the influence of local cryotherapy on the proprioception system. The reviewed literature identified several tests that evaluate different aspects of proprioception. There is no universally agreed protocol, or clear set of criteria for test conditions. The outcomes of different tests and assessments of cryotherapy procedures using different cold modalities are poorly correlated. In general, the published results on the mechanism of cryotherapy effects on proprioception are not uniquely conclusive and are frequently contradictory. Additional high-quality research is required to explicitly answer the following questions: (1) whether local cryotherapy influences all aspects of proprioception; (2) whether the current methods of evaluation are adequate for the exploration of the relationship between cryotherapy and proprioception; and (3) whether the application of local cryotherapy is safe for athletes regarding proprioception. The review clearly showed that there is no comprehensive model relating cryotherapy and proprioception. Mariusz Paweł Furmanek, Kajetan Słomka, and Grzegorz Juras Copyright © 2014 Mariusz Paweł Furmanek et al. All rights reserved. The Analysis of Hand Movement Distinction Based on Relative Frequency Band Energy Method Wed, 05 Nov 2014 12:03:26 +0000 For the purpose of successfully developing a prosthetic control system, many attempts have been made to improve the classification accuracy of surface electromyographic (SEMG) signals. Nevertheless, the effective feature extraction is still a paramount challenge for the classification of SEMG signals. The relative frequency band energy (RFBE) method based on wavelet packet decomposition was proposed for the prosthetic pattern recognition of multichannel SEMG signals. Firstly, the wavelet packet energy of SEMG signals in each subspace was calculated by using wavelet packet decomposition and the RFBE of each frequency band was obtained by the wavelet packet energy. Then, the principal component analysis (PCA) and the Davies-Bouldin (DB) index were used to perform the feature selection. Lastly, the support vector machine (SVM) was applied for the classification of SEMG signals. Our results demonstrated that the RFBE approach was suitable for identifying different types of forearm movements. By comparing with other classification methods, the proposed method achieved higher classification accuracy in terms of the classification of SEMG signals. Yanyan Zhang, Gang Wang, Chaolin Teng, Zhongjiang Sun, and Jue Wang Copyright © 2014 Yanyan Zhang et al. All rights reserved. A Participatory Approach to Develop the Power Mobility Screening Tool and the Power Mobility Clinical Driving Assessment Tool Mon, 08 Sep 2014 05:31:44 +0000 The electric powered wheelchair (EPW) is an indispensable assistive device that increases participation among individuals with disabilities. However, due to lack of standardized assessment tools, developing evidence based training protocols for EPW users to improve driving skills has been a challenge. In this study, we adopt the principles of participatory research and employ qualitative methods to develop the Power Mobility Screening Tool (PMST) and Power Mobility Clinical Driving Assessment (PMCDA). Qualitative data from professional experts and expert EPW users who participated in a focus group and a discussion forum were used to establish content validity of the PMCDA and the PMST. These tools collectively could assess a user’s current level of bodily function and their current EPW driving capacity. Further multicenter studies are necessary to evaluate the psychometric properties of these tests and develop EPW driving training protocols based on these assessment tools. Deepan C. Kamaraj, Brad E. Dicianno, and Rory A. Cooper Copyright © 2014 Deepan C. Kamaraj et al. All rights reserved. Development of a Wheelchair Skills Home Program for Older Adults Using a Participatory Action Design Approach Thu, 04 Sep 2014 00:00:00 +0000 Restricted mobility is the most common impairment among older adults and a manual wheelchair is often prescribed to address these limitations. However, limited access to rehabilitation services results in older adults typically receiving little or no mobility training when they receive a wheelchair. As an alternative and novel approach, we developed a therapist-monitored wheelchair skills home training program delivered via a computer tablet. To optimize efficacy and adherence, principles of self-efficacy and adult learning theory were foundational in the program design. A participatory action design approach was used to engage older adult wheelchair users, care providers, and prescribing clinicians in an iterative design and development process. A series of prototypes were fabricated and revised, based on feedback from eight stakeholder focus groups, until a final version was ready for evaluation in a clinical trial. Stakeholder contributions affirmed and enhanced the foundational theoretical principles and provided validation of the final product for the target population. Edward M. Giesbrecht, William C. Miller, Ian M. Mitchell, and Roberta L. Woodgate Copyright © 2014 Edward M. Giesbrecht et al. All rights reserved. Effect of Wheelchair Frame Material on Users’ Mechanical Work and Transmitted Vibration Wed, 03 Sep 2014 06:15:42 +0000 Wheelchair propulsion exposes the user to a high risk of shoulder injury and to whole-body vibration that exceeds recommendations of ISO 2631-1:1997. Reducing the mechanical work required to travel a given distance (WN-WPM, weight-normalized work-per-meter) can help reduce the risk of shoulder injury, while reducing the vibration transmissibility (VT) of the wheelchair frame can reduce whole-body vibration. New materials such as titanium and carbon are used in today’s wheelchairs and are advertised to improve both parameters, but current knowledge on this matter is limited. In this study, WN-WPM and VT were measured simultaneously and compared between six folding wheelchairs (1 titanium, 1 carbon, and 4 aluminium). Ten able-bodied users propelled the six wheelchairs on three ground surfaces. Although no significant difference of WN-WPM was found between wheelchairs , significant differences of VT were found . The carbon wheelchair had the lowest VT. Contrarily to current belief, the titanium wheelchair VT was similar to aluminium wheelchairs. A negative correlation between VT and WN-WPM was found, which means that reducing VT may be at the expense of increasing WN-WPM. Based on our results, use of carbon in wheelchair construction seems promising to reduce VT without increasing WN-WPM. Félix Chénier and Rachid Aissaoui Copyright © 2014 Félix Chénier and Rachid Aissaoui. All rights reserved. Grasps Recognition and Evaluation of Stroke Patients for Supporting Rehabilitation Therapy Tue, 02 Sep 2014 12:15:28 +0000 Stroke survivors often suffer impairments on their wrist and hand. Robot-mediated rehabilitation techniques have been proposed as a way to enhance conventional therapy, based on intensive repeated movements. Amongst the set of activities of daily living, grasping is one of the most recurrent. Our aim is to incorporate the detection of grasps in the machine-mediated rehabilitation framework so that they can be incorporated into interactive therapeutic games. In this study, we developed and tested a method based on support vector machines for recognizing various grasp postures wearing a passive exoskeleton for hand and wrist rehabilitation after stroke. The experiment was conducted with ten healthy subjects and eight stroke patients performing the grasping gestures. The method was tested in terms of accuracy and robustness with respect to intersubjects’ variability and differences between different grasps. Our results show reliable recognition while also indicating that the recognition accuracy can be used to assess the patients’ ability to consistently repeat the gestures. Additionally, a grasp quality measure was proposed to measure the capabilities of the stroke patients to perform grasp postures in a similar way than healthy people. These two measures can be potentially used as complementary measures to other upper limb motion tests. Beatriz Leon, Angelo Basteris, Francesco Infarinato, Patrizio Sale, Sharon Nijenhuis, Gerdienke Prange, and Farshid Amirabdollahian Copyright © 2014 Beatriz Leon et al. All rights reserved. Electromyographic Assessment of Functional Symmetry of Paraspinal Muscles during Static Exercises in Adolescents with Idiopathic Scoliosis Tue, 02 Sep 2014 08:36:04 +0000 Background. The question of how to correct and rehabilitate scoliosis remains one of the most difficult problems of orthopaedics. Controversies continue to arise regarding various types of both symmetric and asymmetric scoliosis-specific therapeutic exercises. Objective. The aim of the present paper was to conduct an electromyographic assessment of functional symmetry of paraspinal muscles during symmetric and asymmetric exercises in adolescents with idiopathic scoliosis. Materials and Methods. The study was conducted in a group of 82 girls, mean age 12.4 ± 2.3 years with single- or double-major-idiopathic scoliosis, Cobb angle 24 ± 9.4°. The functional biopotentials during isometric work of paraspinal muscles in “at rest” position and during two symmetric and four asymmetric exercises were measured with the use of the Muscle Tester ME 6000 electromyograph. Results. In general, asymmetric exercises were characterised by larger differences in bioelectrical activity of paraspinal muscles, in comparison with symmetric exercises, both in the groups of patients with single-curve and double-curve scoliosis. Conclusion. During symmetric and asymmetric exercises, muscle tension patterns differed significantly in both groups, in comparison with the examination at rest, in most cases generating positive corrective patterns. Asymmetric exercises generated divergent muscle tension patterns on the convex and concave sides of the deformity. Wiesław Chwała, Agnieszka Koziana, Tadeusz Kasperczyk, Robert Walaszek, and Maciej Płaszewski Copyright © 2014 Wiesław Chwała et al. All rights reserved. Neural Coding for Effective Rehabilitation Tue, 02 Sep 2014 08:18:28 +0000 Successful neurological rehabilitation depends on accurate diagnosis, effective treatment, and quantitative evaluation. Neural coding, a technology for interpretation of functional and structural information of the nervous system, has contributed to the advancements in neuroimaging, brain-machine interface (BMI), and design of training devices for rehabilitation purposes. In this review, we summarized the latest breakthroughs in neuroimaging from microscale to macroscale levels with potential diagnostic applications for rehabilitation. We also reviewed the achievements in electrocorticography (ECoG) coding with both animal models and human beings for BMI design, electromyography (EMG) interpretation for interaction with external robotic systems, and robot-assisted quantitative evaluation on the progress of rehabilitation programs. Future rehabilitation would be more home-based, automatic, and self-served by patients. Further investigations and breakthroughs are mainly needed in aspects of improving the computational efficiency in neuroimaging and multichannel ECoG by selection of localized neuroinformatics, validation of the effectiveness in BMI guided rehabilitation programs, and simplification of the system operation in training devices. Xiaoling Hu, Yiwen Wang, Ting Zhao, and Aysegul Gunduz Copyright © 2014 Xiaoling Hu et al. All rights reserved. A Blood Pressure Monitoring Method for Stroke Management Sun, 17 Aug 2014 12:16:54 +0000 Blood pressure is one important risk factor for stroke prognosis. Therefore, continuous monitoring of blood pressure is crucial for preventing and predicting stroke. However, current blood pressure devices are mainly air-cuff based, which only can provide measurements intermittently. This study proposed a new blood pressure estimation method based on the pulse transit time to realize continuous monitoring. The proposed method integrated a linear model with a compensation algorithm. A calibration method was further developed to guarantee that the model was personalized for individuals. Variation and variability of pulse transit time were introduced to construct the compensation algorithm in the model. The proposed method was validated by the data collected from 30 healthy subjects, aged from 23 to 25 years old. By comparing the estimated value to the measurement from an oscillometry, the result showed that the mean error of the estimated blood pressure was  mmHg and  mmHg for systolic and diastolic blood pressure, respectively. In addition, the estimation performance of the proposed model is better than the linear model, especially for the diastolic blood pressure. The results indicate that the proposed method has promising potential to realize continuous blood pressure measurement. Heather Ting Ma Copyright © 2014 Heather Ting Ma. All rights reserved. DWI-Based Neural Fingerprinting Technology: A Preliminary Study on Stroke Analysis Tue, 12 Aug 2014 10:40:57 +0000 Stroke is a common neural disorder in neurology clinics. Magnetic resonance imaging (MRI) has become an important tool to assess the neural physiological changes under stroke, such as diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI). Quantitative analysis of MRI images would help medical doctors to localize the stroke area in the diagnosis in terms of structural information and physiological characterization. However, current quantitative approaches can only provide localization of the disorder rather than measure physiological variation of subtypes of ischemic stroke. In the current study, we hypothesize that each kind of neural disorder would have its unique physiological characteristics, which could be reflected by DWI images on different gradients. Based on this hypothesis, a DWI-based neural fingerprinting technology was proposed to classify subtypes of ischemic stroke. The neural fingerprint was constructed by the signal intensity of the region of interest (ROI) on the DWI images under different gradients. The fingerprint derived from the manually drawn ROI could classify the subtypes with accuracy 100%. However, the classification accuracy was worse when using semiautomatic and automatic method in ROI segmentation. The preliminary results showed promising potential of DWI-based neural fingerprinting technology in stroke subtype classification. Further studies will be carried out for enhancing the fingerprinting accuracy and its application in other clinical practices. Chenfei Ye, Heather Ting Ma, Jun Wu, Pengfei Yang, Xuhui Chen, Zhengyi Yang, and Jingbo Ma Copyright © 2014 Chenfei Ye et al. All rights reserved. Detailed Shoulder MRI Findings in Manual Wheelchair Users with Shoulder Pain Mon, 11 Aug 2014 00:00:00 +0000 Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities. Melissa M. B. Morrow, Meegan G. Van Straaten, Naveen S. Murthy, Jonathan P. Braman, Elia Zanella, and Kristin D. Zhao Copyright © 2014 Melissa M. B. Morrow et al. All rights reserved. The Relationship between Independent Transfer Skills and Upper Limb Kinetics in Wheelchair Users Tue, 05 Aug 2014 12:41:39 +0000 Transfers are one of the most physically demanding wheelchair activities. The purpose of this study was to determine if using proper transfer skills as measured by the Transfer Assessment Instrument (TAI) is associated with reduced loading on the upper extremities. Twenty-three wheelchair users performed transfers to a level-height bench while a series of forces plates, load cells, and a motion capture system recorded the biomechanics of their natural transferring techniques. Their transfer skills were simultaneously evaluated by two study clinicians using the TAI. Logistic regression and multiple linear regression models were used to determine the relationships between TAI scores and the kinetic variables on both arms across all joints. The results showed that the TAI measured transfer skills were closely associated with the magnitude and timing of joint moments , model R2 values ranged from 0.27 to 0.79). Proper completion of the skills which targeted the trailing arm was associated with lower average resultant moments and rates of rise of resultant moments at the trailing shoulder and/or elbow. Some skills involving the leading side had the effect of increasing the magnitude or rate loading on the leading side. Knowledge of the kinetic outcomes associated with each skill may help users to achieve the best load-relieving effects for their upper extremities. Chung-Ying Tsai, Nathan S. Hogaboom, Michael L. Boninger, and Alicia M. Koontz Copyright © 2014 Chung-Ying Tsai et al. All rights reserved. The Relationship between Specific Cognitive Domains, Fear of Falling, and Falls in People with Multiple Sclerosis Thu, 24 Jul 2014 07:33:21 +0000 The primary aim was to examine the relationship between seven definite aspects of cognition measured by a computerized cognitive testing tool on the history falls in people with mild to moderate MS (PwMS). Secondary aims focused on whether cognition performance is correlated to fear of falling, walking velocity, and a patient-rated measure of walking ability. One hundred and one PwMS were included in the study analysis. Fifty-two had a history of at least one fall during the past year. Outcome measures included a computerized cognitive test battery designed to evaluate multiple cognitive domains, gait speed, and self-reported questionnaires; 12-item MS walking scale (MSWS-12); and Falls Efficacy Scale International. Significant differences between fallers and nonfallers were exhibited in attention and verbal function, scoring 7.5% () and 6.2% (), respectively, below the parallel scores of the nonfallers. Attention was the only cognitive component significantly correlated with the MSWS-12 self-reported questionnaire. Fear of falling was significantly correlated with 6 (out of 7) definite cognitive variables. The present findings support the concept that when evaluating and attempting to reduce fall risk, emphasis should be placed not only on traditional fall risk factors like muscle strength and motor function, but also on cognitive function. Alon Kalron Copyright © 2014 Alon Kalron. All rights reserved. Effects of Repetitive Shoulder Activity on the Subacromial Space in Manual Wheelchair Users Sun, 20 Jul 2014 10:18:37 +0000 This study investigated (1) the effect of repetitive weight-relief raises (WR) and shoulder external rotation (ER) on the acromiohumeral distance (AHD) among manual wheelchair users (MWUs) and (2) the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired -tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space () occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (). Increased shoulder pain was associated with AHD percentage narrowing after ER (). The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain. Yen-Sheng Lin, Michael Boninger, Lynn Worobey, Shawn Farrokhi, and Alicia Koontz Copyright © 2014 Yen-Sheng Lin et al. All rights reserved. Anatomic Changes in the Macroscopic Morphology and Microarchitecture of Denervated Long Bone Tissue after Spinal Cord Injury in Rats Sun, 20 Jul 2014 08:53:11 +0000 To study the effects of mechanical loading on bones after SCI, we assessed macro- and microscopic anatomy in rats submitted to passive standing (PS) and electrical stimulation (ES). The study design was based on two main groups of juvenile male Wistar rats with SCI: one was followed for 33 days with therapies starting at day 3 and the other was followed for 63 days with therapies starting at day 33. Both groups were composed of four subgroups (/group): (1) Sham, (2) SCI, (3) SCI + PS, and (4) SCI + ES. Rehabilitation protocol consisted of a 20-minute session, 3x/wk for 30 days. The animals were sequentially weighed and euthanized. The femur and tibia were assessed macroscopically and microscopically by scanning electronic microscopy (SEM). The SCI rats gained less weight than Sham-operated animals. Significant reduction of bone mass and periosteal radii was observed in the SCI rats, whereas PS and ES efficiently improved the macroscopic parameters. The SEM images showed less and thin trabecular bone in SCI rats. PS and ES efficiently ameliorated the bone microarchitecture deterioration by thickening and increasing the trabeculae. Based on the detrimental changes in bone tissue following SCI, the mechanical loading through weight bearing and muscle contraction may decrease the bone loss and restore the macro- and microanatomy. Ariane Zamarioli, Daniel A. Maranho, Mariana M. Butezloff, Patrícia A. Moura, José Batista Volpon, and Antônio C. Shimano Copyright © 2014 Ariane Zamarioli et al. All rights reserved. Circuit Models and Experimental Noise Measurements of Micropipette Amplifiers for Extracellular Neural Recordings from Live Animals Wed, 16 Jul 2014 00:00:00 +0000 Glass micropipettes are widely used to record neural activity from single neurons or clusters of neurons extracellularly in live animals. However, to date, there has been no comprehensive study of noise in extracellular recordings with glass micropipettes. The purpose of this work was to assess various noise sources that affect extracellular recordings and to create model systems in which novel micropipette neural amplifier designs can be tested. An equivalent circuit of the glass micropipette and the noise model of this circuit, which accurately describe the various noise sources involved in extracellular recordings, have been developed. Measurement schemes using dead brain tissue as well as extracellular recordings from neurons in the inferior colliculus, an auditory brain nucleus of an anesthetized gerbil, were used to characterize noise performance and amplification efficacy of the proposed micropipette neural amplifier. According to our model, the major noise sources which influence the signal to noise ratio are the intrinsic noise of the neural amplifier and the thermal noise from distributed pipette resistance. These two types of noise were calculated and measured and were shown to be the dominating sources of background noise for in vivo experiments. Chang Hao Chen, Sio Hang Pun, Peng Un Mak, Mang I Vai, Achim Klug, and Tim C. Lei Copyright © 2014 Chang Hao Chen et al. All rights reserved. Movement Type Prediction before Its Onset Using Signals from Prefrontal Area: An Electrocorticography Study Mon, 14 Jul 2014 11:13:06 +0000 Power changes in specific frequency bands are typical brain responses during motor planning or preparation. Many studies have demonstrated that, in addition to the premotor, supplementary motor, and primary sensorimotor areas, the prefrontal area contributes to generating such responses. However, most brain-computer interface (BCI) studies have focused on the primary sensorimotor area and have estimated movements using postonset period brain signals. Our aim was to determine whether the prefrontal area could contribute to the prediction of voluntary movement types before movement onset. In our study, electrocorticography (ECoG) was recorded from six epilepsy patients while performing two self-paced tasks: hand grasping and elbow flexion. The prefrontal area was sufficient to allow classification of different movements through the area’s premovement signals (−2.0 s to 0 s) in four subjects. The most pronounced power difference frequency band was the beta band (13–30 Hz). The movement prediction rate during single trial estimation averaged 74% across the six subjects. Our results suggest that premovement signals in the prefrontal area are useful in distinguishing different movement tasks and that the beta band is the most informative for prediction of movement type before movement onset. Seokyun Ryun, June Sic Kim, Sang Hun Lee, Sehyoon Jeong, Sung-Phil Kim, and Chun Kee Chung Copyright © 2014 Seokyun Ryun et al. All rights reserved. Using Ecological Momentary Assessment to Evaluate Current Physical Activity Mon, 14 Jul 2014 00:00:00 +0000 Objective. The purpose of this study was to assess the value of ecological momentary assessment in evaluating physical activity among children, adolescents, and adults. It also determines whether ecological momentary assessment fulfills the criteria of validity, reliability, objectivity, norms, and standardization applied to the tools used for the evaluation of physical activity. Methods. The EBSCO-CINHAL, Medline, PsycINFO, PubMed, and SPORTDiscuss databases were reviewed in December 2012 for articles associated with EMA. Results. Of the 20 articles examined, half (10) used electronic methods for data collection, although various methods were used, ranging from pen and paper to smartphone applications. Ten studies used objective monitoring equipment. Nineteen studies were performed over 4 days. While the validity of the EMA method was discussed in 18 studies, only four found it to be objective. In all cases, the EMA procedures were precisely documented and confirmed to be feasible. Conclusions. Ecological momentary assessment is a valid, reliable, and feasible approach to evaluate activity and sedentary behavior. Researchers should be aware that while ecological momentary assessment offers many benefits, it simultaneously imposes many limitations which should be considered when studying physical activity. Jolanta Marszalek, Natalia Morgulec-Adamowicz, Izabela Rutkowska, and Andrzej Kosmol Copyright © 2014 Jolanta Marszalek et al. All rights reserved. Assessment of Waveform Similarity in Clinical Gait Data: The Linear Fit Method Sun, 13 Jul 2014 06:58:39 +0000 The assessment of waveform similarity is a crucial issue in gait analysis for the comparison of kinematic or kinetic patterns with reference data. A typical scenario is in fact the comparison of a patient’s gait pattern with a relevant physiological pattern. This study aims to propose and validate a simple method for the assessment of waveform similarity in terms of shape, amplitude, and offset. The method relies on the interpretation of these three parameters, obtained through a linear fit applied to the two data sets under comparison plotted one against the other after time normalization. The validity of this linear fit method was tested in terms of appropriateness (comparing real gait data of 34 patients with cerebrovascular accident with those of 15 healthy subjects), reliability, sensitivity, and specificity (applying a cluster analysis on the real data). Results showed for this method good appropriateness, 94.1% of sensitivity, 93.3% of specificity, and good reliability. The LFM resulted in a simple method suitable for analysing the waveform similarity in clinical gait analysis. M. Iosa, A. Cereatti, A. Merlo, I. Campanini, S. Paolucci, and A. Cappozzo Copyright © 2014 M. Iosa et al. All rights reserved. The Effectiveness of Functional Electrical Stimulation Based on a Normal Gait Pattern on Subjects with Early Stroke: A Randomized Controlled Trial Thu, 10 Jul 2014 07:34:54 +0000 Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (), a placebo group (), or a dual-channel group (). Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA), the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Modified Barthel Index (MBI). Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke. Zhimei Tan, Huihua Liu, Tiebin Yan, Dongmei Jin, Xiaokuo He, Xiuyuan Zheng, Shuwei Xu, and Chunmei Tan Copyright © 2014 Zhimei Tan et al. All rights reserved. Sliding and Lower Limb Mechanics during Sit-Stand-Sit Transitions with a Standing Wheelchair Sun, 06 Jul 2014 07:32:30 +0000 Purpose. This study aimed to investigate the shear displacement between the body and backrest/seat, range of motion (ROM), and force acting on the lower limb joints during sit-stand-sit transitions by operating an electric-powered standing wheelchair. Methods and Materials. The amounts of sliding along the backrest and the seat plane, ROM of lower limb joints, and force acting on the knee/foot were measured in twenty-four people with paraplegia. Results. Without an antishear mechanism, the shear displacement was approximately 9 cm between the user’s body and the backrest/seat surfaces. During standing up, the user’s back slid down and the thigh was displaced rearward, but they moved in opposite directions when wheelchair sat back down. A minimum of 60 degrees of ROM at the hip and knee was needed during sit-stand-sit transitions. The maximal resultant forces acting on the knee restraints could reach 23.5% of body weight. Conclusion. Sliding between the body and backrest/seat occurred while transitioning from sitting to standing and vice versa. A certain amount of ROM at lower limb joints and force acting on the knee was necessitated during sit-stand-sit transitions. Careful consideration needs to be given to who the user of the electric powered standing wheelchair is. Yu-Sheng Yang, Ming-De Chen, Wei-Chien Fang, Jyh-Jong Chang, and Chang-Chih Kuo Copyright © 2014 Yu-Sheng Yang et al. All rights reserved. Robust Deep Network with Maximum Correntropy Criterion for Seizure Detection Sun, 06 Jul 2014 00:00:00 +0000 Effective seizure detection from long-term EEG is highly important for seizure diagnosis. Existing methods usually design the feature and classifier individually, while little work has been done for the simultaneous optimization of the two parts. This work proposes a deep network to jointly learn a feature and a classifier so that they could help each other to make the whole system optimal. To deal with the challenge of the impulsive noises and outliers caused by EMG artifacts in EEG signals, we formulate a robust stacked autoencoder (R-SAE) as a part of the network to learn an effective feature. In R-SAE, the maximum correntropy criterion (MCC) is proposed to reduce the effect of noise/outliers. Unlike the mean square error (MSE), the output of the new kernel MCC increases more slowly than that of MSE when the input goes away from the center. Thus, the effect of those noises/outliers positioned far away from the center can be suppressed. The proposed method is evaluated on six patients of 33.6 hours of scalp EEG data. Our method achieves a sensitivity of 100% and a specificity of 99%, which is promising for clinical applications. Yu Qi, Yueming Wang, Jianmin Zhang, Junming Zhu, and Xiaoxiang Zheng Copyright © 2014 Yu Qi et al. All rights reserved. Temporal Parameters Estimation for Wheelchair Propulsion Using Wearable Sensors Thu, 03 Jul 2014 09:15:30 +0000 Due to lower limb paralysis, individuals with spinal cord injury (SCI) rely on their upper limbs for mobility. The prevalence of upper extremity pain and injury is high among this population. We evaluated the performance of three triaxis accelerometers placed on the upper arm, wrist, and under the wheelchair, to estimate temporal parameters of wheelchair propulsion. Twenty-six participants with SCI were asked to push their wheelchair equipped with a SMARTWheel. The estimated stroke number was compared with the criterion from video observations and the estimated push frequency was compared with the criterion from the SMARTWheel. Mean absolute errors (MAE) and mean absolute percentage of error (MAPE) were calculated. Intraclass correlation coefficients and Bland-Altman plots were used to assess the agreement. Results showed reasonable accuracies especially using the accelerometer placed on the upper arm where the MAPE was 8.0% for stroke number and 12.9% for push frequency. The ICC was 0.994 for stroke number and 0.916 for push frequency. The wrist and seat accelerometer showed lower accuracy with a MAPE for the stroke number of 10.8% and 13.4% and ICC of 0.990 and 0.984, respectively. Results suggested that accelerometers could be an option for monitoring temporal parameters of wheelchair propulsion. Manoela Ojeda and Dan Ding Copyright © 2014 Manoela Ojeda and Dan Ding. All rights reserved. Treatment Outcomes in Patients with Internet Addiction: A Clinical Pilot Study on the Effects of a Cognitive-Behavioral Therapy Program Tue, 01 Jul 2014 11:45:52 +0000 Internet addiction is regarded as a growing health concern in many parts of the world with prevalence rates of 1-2% in Europe and up to 7% in some Asian countries. Clinical research has demonstrated that Internet addiction is accompanied with loss of interests, decreased psychosocial functioning, social retreat, and heightened psychosocial distress. Specialized treatment programs are needed to face this problem that has recently been added to the appendix of the DSM-5. While there are numerous studies assessing clinical characteristics of patients with Internet addiction, the knowledge about the effectiveness of treatment programs is limited. Although a recent meta-analysis indicates that those programs show effects, more clinical studies are needed here. To add knowledge, we conducted a pilot study on the effects of a standardized cognitive-behavioral therapy program for IA. 42 male adults meeting criteria for Internet addiction were enrolled. Their IA-status, psychopathological symptoms, and perceived self-efficacy expectancy were assessed before and after the treatment. The results show that 70.3% of the patients finished the therapy regularly. After treatment symptoms of IA had decreased significantly. Psychopathological symptoms were reduced as well as associated psychosocial problems. The results of this pilot study emphasize findings from the only meta-analysis conducted so far. K. Wölfling, M. E. Beutel, M. Dreier, and K. W. Müller Copyright © 2014 K. Wölfling et al. All rights reserved. Analysis of Asymmetry of the Forces Applied on the Lower Limb in Subjects with Nonspecific Chronic Low Back Pain Tue, 01 Jul 2014 00:00:00 +0000 Objective. Several studies have investigated asymmetry and loading patterns in different spine pathologies, motor disorders, and other conditions; there is a lack of knowledge on these aspects in chronic low back pain (CLBP). The aim of this study was to analyse asymmetry and loading patterns in patients with nonspecific chronic low back pain (NCLBP) compared to normal individuals, during walking. Method. Forty participants (20 healthy subjects and 20 patients with NCLBP) participated in the study. Asymmetry of the force was measured based on the Asymmetry Index (ASI). The difference in the mean values of all data between the two groups was examined using the independent t-test. Results. The mean value of the first peak of ground reaction force of normal subjects was  N/BW compared to  N/BW in NCLBP patients and  N/BW mediolateral force applied on the leg in normal subjects compared to  N/BW in NCLBP patients . The Asymmetry Index (ASI) of the first peak of vertical force was and for NCLBP and normal subjects, respectively, P = 0.2. Conclusion. Therefore, it can be concluded that NCLBP subjects follow avoidance-endurance model without any limitation during walking. Maryam Hassan Zahraee, Mohammad Taghi Karimi, Javid Mostamand, and Francis Fatoye Copyright © 2014 Maryam Hassan Zahraee et al. All rights reserved. Investigation of Peak Pressure Index Parameters for People with Spinal Cord Injury Using Wheelchair Tilt-in-Space and Recline: Methodology and Preliminary Report Thu, 26 Jun 2014 06:02:50 +0000 The purpose of this study was to determine the effect of the sensel window’s location and size when calculating the peak pressure index (PPI) of pressure mapping with varying degrees of wheelchair tilt-in-space (tilt) and recline in people with spinal cord injury (SCI). Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15°, 25°, and 35°) and recline (10° and 30°) were used by the participants in random order. Displacements of peak pressure and center of pressure were extracted from the left side of the mapping system. Normalized PPI was computed for three sensel window dimensions (3 sensels × 3 sensels, 5 × 5, and 7 × 7). At least 3.33 cm of Euclidean displacement of peak pressures was observed in the tilt and recline. For every tilt angle, peak pressure displacement was not significantly different between 10° and 30° recline, while center of pressure displacement was significantly different (). For each recline angle, peak pressure displacement was not significantly different between pairs of 15°, 25°, and 35° tilt, while center of pressure displacement was significantly different between 15° versus 35° and 25° versus 35°. Our study showed that peak pressure displacement occurs in response to wheelchair tilt and recline, suggesting that the selected sensel window locations used to calculate PPI should be adjusted during changes in wheelchair configuration. Chi-Wen Lung, Tim D. Yang, Barbara A. Crane, Jeannette Elliott, Brad E. Dicianno, and Yih-Kuen Jan Copyright © 2014 Chi-Wen Lung et al. All rights reserved. A Study on Decoding Models for the Reconstruction of Hand Trajectories from the Human Magnetoencephalography Sun, 22 Jun 2014 12:41:55 +0000 Decoding neural signals into control outputs has been a key to the development of brain-computer interfaces (BCIs). While many studies have identified neural correlates of kinematics or applied advanced machine learning algorithms to improve decoding performance, relatively less attention has been paid to optimal design of decoding models. For generating continuous movements from neural activity, design of decoding models should address how to incorporate movement dynamics into models and how to select a model given specific BCI objectives. Considering nonlinear and independent speed characteristics, we propose a hybrid Kalman filter to decode the hand direction and speed independently. We also investigate changes in performance of different decoding models (the linear and Kalman filters) when they predict reaching movements only or predict both reach and rest. Our offline study on human magnetoencephalography (MEG) during point-to-point arm movements shows that the performance of the linear filter or the Kalman filter is affected by including resting states for training and predicting movements. However, the hybrid Kalman filter consistently outperforms others regardless of movement states. The results demonstrate that better design of decoding models is achieved by incorporating movement dynamics into modeling or selecting a model according to decoding objectives. Hong Gi Yeom, Wonjun Hong, Da-Yoon Kang, Chun Kee Chung, June Sic Kim, and Sung-Phil Kim Copyright © 2014 Hong Gi Yeom et al. All rights reserved. Advances in Neuromotor Stroke Rehabilitation Thu, 19 Jun 2014 12:38:08 +0000 Giovanni Morone, Stefano Masiero, Cordula Werner, and Stefano Paolucci Copyright © 2014 Giovanni Morone et al. All rights reserved. Gradually Increased Training Intensity Benefits Rehabilitation Outcome after Stroke by BDNF Upregulation and Stress Suppression Thu, 19 Jun 2014 07:11:35 +0000 Physical training is necessary for effective rehabilitation in the early poststroke period. Animal studies commonly use fixed training intensity throughout rehabilitation and without adapting it to the animals' recovered motor ability. This study investigated the correlation between training intensity and rehabilitation efficacy by using a focal ischemic stroke rat model. Eighty male Sprague-Dawley rats were induced with middle cerebral artery occlusion/reperfusion surgery. Sixty rats with successful stroke were then randomly assigned into four groups: control (CG, ), low intensity (LG, ), gradually increased intensity (GIG, ), and high intensity (HG, ). Behavioral tests were conducted daily to evaluate motor function recovery. Stress level and neural recovery were evaluated via plasma corticosterone and brain-derived neurotrophic factor (BDNF) concentration, respectively. GIG rats significantly () recovered motor function and produced higher hippocampal BDNF (112.87 ± 25.18 ng/g). GIG and LG rats exhibited similar stress levels (540.63 ± 117.40 nM/L and 508.07 ± 161.30 nM/L, resp.), which were significantly lower () than that (716.90 ± 156.48 nM/L) of HG rats. Training with gradually increased intensity achieved better recovery with lower stress. Our observations indicate that a training protocol that includes gradually increasing training intensity should be considered in both animal and clinical studies for better stroke recovery. Jing Sun, Zheng Ke, Shea Ping Yip, Xiao-ling Hu, Xiao-xiang Zheng, and Kai-yu Tong Copyright © 2014 Jing Sun et al. All rights reserved. Measurement of Hand/Handrim Grip Forces in Two Different One Arm Drive Wheelchairs Thu, 19 Jun 2014 00:00:00 +0000 Purpose. The aim of this study was to explore the total and regional grip forces in the hand when propelling two different manual one arm drive wheelchairs: the Neater Uni-wheelchair (NUW) and a foot steered Action3 wheelchair. Methods. 17 nondisabled users were randomly assigned to each wheelchair to drive around an indoor obstacle course. The Grip, a multiple sensor system taking continuous measurement of handgrip force, was attached to the propelling hand. Total grip force in each region of the hand and total grip force across the whole hand were calculated per user per wheelchair. Results. The Action3 with foot steering only generated significantly greater total grip force in straight running compared to the NUW and also in the fingers and thumb in straight running. Conclusions. The results suggest that the Action3 with foot steering generated greater grip forces which may infer a greater potential for repetitive strain injury in the upper limb. Further work is required to explore whether the difference in grip force is of clinical significance in a disabled population. Anne Mandy, Lucy Redhead, and Jon Michaelis Copyright © 2014 Anne Mandy et al. All rights reserved. Foot Placement and Arm Position Affect the Five Times Sit-to-Stand Test Time of Individuals with Chronic Stroke Mon, 16 Jun 2014 08:33:28 +0000 Objectives. To investigate the effect of two foot placements (normal or posterior placement) and three arm positions (hands on the thighs, arms crossed over chest, and augmented arm position with elbow extended) on the five times sit-to-stand (FTSTS) test times of individuals with chronic stroke. Design. Cross-sectional study. Setting. University-based rehabilitation clinic. Participants. A convenience sample of community-dwelling individuals with chronic stroke . Methods. The times in completing the FTSTS with two foot placements and the three arm positions were recorded by stopwatch. Results. Posterior foot placement led to significantly shorter FTSTS times when compared with normal foot placement in all the 3 arm positions . In addition, hands on thigh position led to significantly longer FTSTS times than the augmented arm position . Conclusion. Our results showed that foot placement and arm position could influence the FTSTS times of individuals with chronic stroke. Standardizing the foot placement and arm position in the test procedure is essential, if FTSTS test is intended to be used repeatedly on the same subject. Patrick W. H. Kwong, Shamay S. M. Ng, Raymond C. K. Chung, and Gabriel Y. F. Ng Copyright © 2014 Patrick W. H. Kwong et al. All rights reserved. Muscle-Based Pharmacokinetic Modeling of Marrow Perfusion for Osteoporotic Bone in Females Mon, 09 Jun 2014 12:06:19 +0000 The pharmacokinetic model has been widely used in tissue perfusion analysis, such as bone marrow perfusion. In the modeling process, the arterial input function is important to guarantee the reliability of the fitting result. However, the arterial input function is variable and hard to control, which makes it difficult to compare results across different studies. The purpose of this study was to establish a muscle-based pharmacokinetic model for bone marrow perfusion without using arterial input function. Erector spinae muscle around the vertebral body was selected as the reference region. The study was carried out in elderly females with different bone mineral densities (normal, osteopenia, and osteoporosis). Quantitative parameters were extracted from the pharmacokinetic model. Parameter Ktrans,BM (contrast agent extravasation rate constants for blood perfusion of the bone marrow) showed a significant reduction in subjects with lower bone mineral density, which is consistent with previous studies. However, muscle perfusion parameters remained unchanged among different groups. The results indicated that the muscle-based model was stable for bone marrow perfusion modeling. Additionally, nonsignificant change in muscle parameters indicated that the diminished perfusion is only a local rather than a systematic change in the bone marrow for osteoporosis. Heather Ting Ma, James F. Griffth, and Ping-Chung Leung Copyright © 2014 Heather Ting Ma et al. All rights reserved. Analysing Psychosocial Difficulties in Depression: A Content Comparison between Systematic Literature Review and Patient Perspective Mon, 09 Jun 2014 09:14:06 +0000 Despite all the knowledge on depression, it is still unclear whether current literature covers all the psychosocial difficulties (PSDs) important for depressed patients. The aim of the present study was to identify the gaps in the recent literature concerning PSDs and their related variables. Psychosocial difficulties were defined according to the World Health Organization International Classification of Functioning, Disability and Health (ICF). A comparative approach between a systematic literature review, a focus group, and individual interviews with depressed patients was used. Literature reported the main psychosocial difficulties almost fully, but not in the same degree of importance as patients’ reports. Furthermore, the covered areas were very general and related to symptomatology. Regarding the related variables, literature focused on clinical variables and treatments above all but did not report that many psychosocial difficulties influence other PSDs. This study identified many existing research gaps in recent literature mainly in the area of related variables of PSDs. Future steps in this direction are needed. Moreover, we suggest that clinicians select interventions covering not only symptoms, but also PSDs and their modifiable related variables. Furthermore, identification of interventions for particular psychosocial difficulties and personalisation of therapies according to individuals’ PSDs are necessary. Kaloyan Kamenov, Blanca Mellor-Marsá, Itziar Leal, Jose Luis Ayuso-Mateos, and Maria Cabello Copyright © 2014 Kaloyan Kamenov et al. All rights reserved. Translation and Initial Validation of the Chinese (Cantonese) Version of Community Integration Measure for Use in Patients with Chronic Stroke Wed, 04 Jun 2014 06:01:20 +0000 Objectives. To (1) translate and culturally adapt the English version Community Integration Measure into Chinese (Cantonese), (2) report the results of initial validation of the Chinese (Cantonese) version of CIM (CIM-C) including the content validity, internal consistency, test-retest reliability, and factor structure of CIM-C for use in stroke survivors in a Chinese community setting, and (3) investigate the level of community integration of stroke survivors living in Hong Kong. Design. Cross-sectional study. Setting. University-based rehabilitation centre. Participants. 62 () subjects with chronic stroke. Methods. The CIM-C was produced after forward-backward translation, expert panel review, and pretesting. 25 () of the same subjects were reassessed after a 1-week interval. Results. The items of the CIM-C demonstrated high internal consistency with a Cronbach’s α of 0.84. The CIM-C showed good test-retest reliability with an intraclass correlation coefficient (ICC) of 0.84 (95% confidence interval, 0.64–0.93). A 3-factor structure of the CIM-C including “relationship and engagement,” “sense of knowing,” and “independent living,” was consistent with the original theoretical model. Hong Kong stroke survivors revealed a high level of community integration as measured by the CIM-C (mean (SD): 43.48 (5.79)). Conclusions. The CIM-C is a valid and reliable measure for clinical use. Tai-Wa Liu, Shamay S. M. Ng, and Gabriel Y. F. Ng Copyright © 2014 Tai-Wa Liu et al. All rights reserved. Feedback-Mediated Upper Extremities Exercise: Increasing Patient Motivation in Poststroke Rehabilitation Mon, 02 Jun 2014 09:12:16 +0000 Purpose. This proof-of-concept study investigated whether feedback-mediated exercise (FME) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function, compared to no-feedback exercise (NFE). Method. We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements. Twenty poststroke hemiplegic inpatients, randomly assigned to the FME and NFE group, received therapy five days a week for three weeks. The outcome measures were evaluated from the following: (1) the modified drawing test (mDT), (2) received therapy time—RTT, and (3) intrinsic motivation inventory—IMI. Results. The FME group patients showed significantly higher improvement in the speed metric (), and smoothness metric (), as well as higher RTT (). Significantly higher patient motivation is observed in the FME group (interest/enjoyment subscale () and perceived competence subscale ()). Conclusion. Prolonged endurance in training and greater improvement in certain areas of motor function, as well as very high patient motivation and strong positive impressions about the treatment, suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients. Maša D. Popović, Miloš D. Kostić, Sindi Z. Rodić, and Ljubica M. Konstantinović Copyright © 2014 Maša D. Popović et al. All rights reserved. Predictors of Poststroke Health-Related Quality of Life in Nigerian Stroke Survivors: A 1-Year Follow-Up Study Wed, 28 May 2014 10:43:56 +0000 This study aims to identify the predictors in the different aspects of the health-related quality of life (HRQoL) and to measure the changes of functional status over time in a cohort of Nigerian stroke survivors. A prospective observational study was conducted in three hospitals of Kano state of Nigeria where stroke survivors receive rehabilitation. The linguistic-validated Hausa versions of the stroke impact scale 3.0, modified Rankin scale, Barthel index and Beck depression inventory scales were used. Paired samples -test was used to calculate the amount of changes that occur over time and the forward stepwise linear regression model was used to identify the predictors. A total of 233 stroke survivors were surveyed at 6 months, and 93% (217/233) were followed at 1 year after stroke. Functional disabilities were significantly reduced during the recovery phase. Motor impairment, disability, and level of depression were independent predictors of HRQoL in the multivariate regression analysis. The involvement of family members as caregivers is the key factor for those survivors with improved functional status. Thus, to enhance the quality of poststroke life, it is proposed that a holistic stroke rehabilitation service and an active involvement of family members are established at every possible level. Ashiru Mohammad Hamza, Nabilla Al-Sadat, Siew Yim Loh, and Nowrozy Kamar Jahan Copyright © 2014 Ashiru Mohammad Hamza et al. All rights reserved. Sharp Turning and Corner Turning: Comparison of Energy Expenditure, Gait Parameters, and Level of Fatigue among Community-Dwelling Elderly Wed, 28 May 2014 00:00:00 +0000 This study compares energy expenditure (EE), gait parameters (GP), and level of fatigue (LOF) between 5-minute walking with sharp turning (ST) and corner turning (CT). Data were obtained from 29 community-dwelling elderly (mean age, 62.7 ± 3.54 years). For 5 minutes, in ST task, participants walked on a 3-meter pathway with 2 cones placed at each end (180° turning), while in CT task, participants walked on a 6-meter pathway with 4 cones placed at 4 corners (90° turning). The physiological cost index, pedometer, and 10-point Modified Borg Dyspnoea Scale were used to measure EE (beats/min), GP (no of steps), and LOF, respectively. Data were analyzed by using independent -tests. EE during ST (0.62 ± 0.21 beats/min) was significantly higher than CT (0.48 ± 0.17 beats/min) (). GP (434 ± 92.93 steps) and LOF (1.40 ± 1.11) in ST were found to be lower compared to GP (463 ± 92.18 steps) and LOF (1.54 ± 1.34) in CT (All, ). Higher EE in ST could be due to the difficulty in changing to a 180° direction, which may involve agility and different turning strategies (step-turn or pivot-turn) to adjust the posture carefully. In CT, participants could choose a step-turn strategy to change to a 90° direction, which was less challenging to postural control. Maria Justine, Haidzir Manaf, Affeenddie Sulaiman, Shahir Razi, and Hani Asilah Alias Copyright © 2014 Maria Justine et al. All rights reserved. Action Observation Therapy in the Subacute Phase Promotes Dexterity Recovery in Right-Hemisphere Stroke Patients Thu, 22 May 2014 11:35:48 +0000 The clinical impact of action observation (AO) on upper limb functional recovery in subacute stroke patients is recent evidence. We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one. Sixty-seven first-ever ischemic stroke subjects were randomly assigned to receive upper limb training coupled with AO tasks or standard rehabilitation. The groups were matched by age and gender, Bamford category, and interval from stroke and lesion side. Fugl-Meyer (FM) and Box and Block Test (BBT) were used to measure hand function recovery at the end (T1) and 4-5 months after the treatment (T2). At T1, FM was increased by 31% (±26%), of maximum achievable recovery, whereas BBT was increased by 17% (±18%); at T2, FM had reached 43% (±45%) of maximum recovery, while BBT had reached 25% (±22%). Combining the effects of treatment to those of lesion side revealed significantly higher gains, in both FM and BBT scores, in left hemiparetic subjects when exposed to AO as compared to standard rehabilitation alone (). The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients. Patrizio Sale, Maria Gabriella Ceravolo, and Marco Franceschini Copyright © 2014 Patrizio Sale et al. All rights reserved. Concurrent Validity of Physiological Cost Index in Walking over Ground and during Robotic Training in Subacute Stroke Patients Mon, 19 May 2014 13:01:27 +0000 Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (); in CG Pearson correlation was 0.852 (). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients. Anna Sofia Delussu, Giovanni Morone, Marco Iosa, Maura Bragoni, Stefano Paolucci, and Marco Traballesi Copyright © 2014 Anna Sofia Delussu et al. All rights reserved. Neural Decoding Using a Parallel Sequential Monte Carlo Method on Point Processes with Ensemble Effect Sun, 18 May 2014 07:51:49 +0000 Sequential Monte Carlo estimation on point processes has been successfully applied to predict the movement from neural activity. However, there exist some issues along with this method such as the simplified tuning model and the high computational complexity, which may degenerate the decoding performance of motor brain machine interfaces. In this paper, we adopt a general tuning model which takes recent ensemble activity into account. The goodness-of-fit analysis demonstrates that the proposed model can predict the neuronal response more accurately than the one only depending on kinematics. A new sequential Monte Carlo algorithm based on the proposed model is constructed. The algorithm can significantly reduce the root mean square error of decoding results, which decreases 23.6% in position estimation. In addition, we accelerate the decoding speed by implementing the proposed algorithm in a massive parallel manner on GPU. The results demonstrate that the spike trains can be decoded as point process in real time even with 8000 particles or 300 neurons, which is over 10 times faster than the serial implementation. The main contribution of our work is to enable the sequential Monte Carlo algorithm with point process observation to output the movement estimation much faster and more accurately. Kai Xu, Yiwen Wang, Fang Wang, Yuxi Liao, Qiaosheng Zhang, Hongbao Li, and Xiaoxiang Zheng Copyright © 2014 Kai Xu et al. All rights reserved. Nonlinear EEG Decoding Based on a Particle Filter Model Thu, 15 May 2014 15:49:24 +0000 While the world is stepping into the aging society, rehabilitation robots play a more and more important role in terms of both rehabilitation treatment and nursing of the patients with neurological diseases. Benefiting from the abundant contents of movement information, electroencephalography (EEG) has become a promising information source for rehabilitation robots control. Although the multiple linear regression model was used as the decoding model of EEG signals in some researches, it has been considered that it cannot reflect the nonlinear components of EEG signals. In order to overcome this shortcoming, we propose a nonlinear decoding model, the particle filter model. Two- and three-dimensional decoding experiments were performed to test the validity of this model. In decoding accuracy, the results are comparable to those of the multiple linear regression model and previous EEG studies. In addition, the particle filter model uses less training data and more frequency information than the multiple linear regression model, which shows the potential of nonlinear decoding models. Overall, the findings hold promise for the furtherance of EEG-based rehabilitation robots. Jinhua Zhang, Jiongjian Wei, Baozeng Wang, Jun Hong, and Jing Wang Copyright © 2014 Jinhua Zhang et al. All rights reserved. Inter- and Intrarater Reliability of Modified Lateral Scapular Slide Test in Healthy Athletic Men Tue, 13 May 2014 00:00:00 +0000 Objective. The reliability of lateral scapular slide test (LSST) at 90 degrees of abduction is controversial; therefore, in order to achieve more reliability it may be necessary to make changes in this particular position. Methods. Modified lateral scapular slide test (MLSST) was done on thirty male basketball players with two examiners in one session and for the retest with one examiner in the next week. The test was done in 7 positions: arm relaxed at the side (P1), 90 degrees of abduction (P2), 90 degrees of scaption without having a weight in hands (P3), 90 degrees of scaption with having 3 different weights (1, 2, and 4 kg) in hands (P4, P5, and P6, resp.), and 180 degrees of scaption without having a weight in hands (P7). Results. In P1 and P6, the ICC scores indicated the highest level of intrarater reliability. In P2, the ICC scores showed a fair level of intrarater reliability, as the minimum reliability. The maximum and minimum interrater reliability were P1 and P4, respectively. Conclusion. Scaption with loading, as a functional position in the overhead athletes, is a reliable positioning and may be replaced with the third position of the traditional LSST. Azadeh Shadmehr, Mohammad Hassan Azarsa, and Shohreh Jalaie Copyright © 2014 Azadeh Shadmehr et al. All rights reserved. Effects of Synergistic Massage and Physical Exercise on the Expression of Angiogenic Markers in Rat Tendons Mon, 12 May 2014 06:50:00 +0000 Physical exercise and massage are regarded as key factors in regulating tendon structure. However, information on the mechanism through which massage influences the structure and biology of a tendon is scarce. In this study, we attempted to define the impact of these two activities on rat tendons by using morphological and molecular techniques, determining the expression of VEGF-A, FGF-2, and CD34 in the tendons of rats subjected to 10 weeks of physical exercise (running) with massage of varied duration. The group of rats that was trained and massaged during the entire study was characterized by the highest expression of these markers, compared to the rats subjected to massage before training and to the control group subjected to physical exercises only. The greatest significant differences, compared to the control, were noted in the expression of all the studied markers at mRNA level, and in the case of VEGF-A, at protein level, in the third and fifth weeks of the experiment. The results of this study could point to the synergistic impact of simultaneous massage and physical exercise on the expression of angiogenesis markers in rat tendons. Waldemar Andrzejewski, Krzysztof Kassolik, Piotr Dziegiel, Bartosz Pula, Katarzyna Ratajczak-Wielgomas, Karolina Jablonska, Donata Kurpas, Tomasz Halski, and Marzena Podhorska-Okolow Copyright © 2014 Waldemar Andrzejewski et al. All rights reserved. Physical Therapy in Wound Healing, Edema, and Urinary Incontinence Sun, 11 May 2014 06:21:39 +0000 Jakub Taradaj, Tomasz Urbanek, Luther C. Kloth, and Marco Romanelli Copyright © 2014 Jakub Taradaj et al. All rights reserved. Quantitative Electroencephalography and Behavioural Correlates of Daytime Sleepiness in Chronic Stroke Tue, 06 May 2014 07:26:56 +0000 Sleepiness is common after stroke, but in contrast to its importance for rehabilitation, existing studies focus primarily on the acute state and often use subjective sleepiness measures only. We used quantitative electroencephalography (qEEG) to extract physiological sleepiness, as well as subjective reports, in response to motor-cognitive demand in stroke patients and controls. We hypothesised that (a) slowing of the EEG is chronically sustained after stroke; (b) increased power in lower frequencies and increased sleepiness are associated; and (c) sleepiness is modulated by motor-cognitive demand. QEEGs were recorded in 32 chronic stroke patients and 20 controls using a Karolinska Drowsiness Test protocol administered before and after a motor priming task. Subjective sleepiness was measured using the Karolinska Sleepiness Scale. The findings showed that power density was significantly increased in delta and theta frequency bands over both hemispheres in patients which were not associated with subjective sleepiness ratings. This effect was not observed in controls. The motor priming task induced differential hemispheric effects with greater increase in low-frequency bands and presumably compensatory increases in higher frequency bands. The results indicate sustained slowing in the qEEG in chronic stroke, but in contrast to healthy controls, these changes are not related to perceived sleepiness. Katherine Herron, Derk-Jan Dijk, Philip Dean, Ellen Seiss, and Annette Sterr Copyright © 2014 Katherine Herron et al. All rights reserved. The Ineffective Role of Cathodal tDCS in Enhancing the Functional Motor Outcomes in Early Phase of Stroke Rehabilitation: An Experimental Trial Mon, 05 May 2014 12:01:43 +0000 Transcranial direct current stimulation (tDCS) is a noninvasive technique that could improve the rehabilitation outcomes in stroke, eliciting neuroplastic mechanisms. At the same time conflicting results have been reported in subacute phase of stroke, when neuroplasticity is crucial. The aim of this double-blind, randomized, and sham-controlled study was to determine whether a treatment with cathodal tDCS before the rehabilitative training might augment the final outcomes (upper limb function, hand dexterity and manual force, locomotion, and activities of daily living) in respect of a traditional rehabilitation for a sample of patients affected by ischemic stroke in the subacute phase. An experimental group (cathodal tDCS plus rehabilitation) and a control group (sham tDCS plus rehabilitation) were assessed at the beginning of the protocol, after 10 days of stimulation, after 30 days from ending of stimulation, and at the end of inpatient rehabilitation. Both groups showed significant improvements for all the assessed domains during the rehabilitation, except for the manual force, while no significant differences were demonstrated between groups. These results seem to indicate that the cathodal tDCS, provided in an early phase of stroke, does not lead to a functional improvement. To depict a more comprehensive scenario, further studies are needed. Augusto Fusco, Federica Assenza, Marco Iosa, Simona Izzo, Riccardo Altavilla, Stefano Paolucci, and Fabrizio Vernieri Copyright © 2014 Augusto Fusco et al. All rights reserved. High-Intensity Physical Training in the Treatment of Chronic Diseases and Disorders Mon, 05 May 2014 07:44:37 +0000 Lars L. Andersen, David G. Behm, Nicola A. Maffiuletti, and Brad J. Schoenfeld Copyright © 2014 Lars L. Andersen et al. All rights reserved. The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial Mon, 05 May 2014 06:51:58 +0000 The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results, whereas little information is available regarding the use of this therapy in subacute stroke patients. The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase. Fifty adult stroke patients participated to the study: 25 subjects were randomly assigned to balance training with Wii Fit, and the other 25 subjects were assigned to usual balance therapy. Both groups were also treated with conventional physical therapy (40 min 2 times/day). The main outcome was functional balance (Berg Balance Scale-BBS), and secondary outcomes were disability (Barthel Index-BI), walking ability (Functional Ambulation Category), and walking speed (10-meters walking test). Wii Fit training was more effective than usual balance therapy in improving balance (BBS: 53 versus 48, ) and independency in activity of daily living (BI: 98 versus 93, ). A balance training performed with a Wii Fit as an add on to the conventional therapy was found to be more effective than conventional therapy alone in improving balance and reducing disability in patients with subacute stroke. Giovanni Morone, Marco Tramontano, Marco Iosa, Jacob Shofany, Antonella Iemma, Massimo Musicco, Stefano Paolucci, and Carlo Caltagirone Copyright © 2014 Giovanni Morone et al. All rights reserved. Differences in Swallowing between High and Low Concentration Taste Stimuli Wed, 30 Apr 2014 12:58:08 +0000 Taste is a property that is thought to potentially modulate swallowing behavior. Whether such effects depend on taste, intensity remains unclear. This study explored differences in the amplitudes of tongue-palate pressures in swallowing as a function of taste stimulus concentration. Tongue-palate pressures were collected in 80 healthy women, in two age groups (under 40, over 60), stratified by genetic taste status (nontasters, supertasters). Liquids with different taste qualities (sweet, sour, salty, and bitter) were presented in high and low concentrations. General labeled magnitude scale ratings captured perceived taste intensity and liking/disliking of the test liquids. Path analysis explored whether factors of taste, concentration, age group, and/or genetic taste status impacted: (1) perceived intensity; (2) palatability; and (3) swallowing pressures. Higher ratings of perceived intensity were found in supertasters and with higher concentrations, which were more liked/disliked than lower concentrations. Sweet stimuli were more palatable than sour, salty, or bitter stimuli. Higher concentrations elicited stronger tongue-palate pressures independently and in association with intensity ratings. The perceived intensity of a taste stimulus varies as a function of stimulus concentration, taste quality, participant age, and genetic taste status and influences swallowing pressure amplitudes. High-concentration salty and sour stimuli elicit the greatest tongue-palate pressures. Ahmed Nagy, Catriona M. Steele, and Cathy A. Pelletier Copyright © 2014 Ahmed Nagy et al. All rights reserved. Design and Reliability of a Novel Heel Rise Test Measuring Device for Plantarflexion Endurance Wed, 30 Apr 2014 11:18:55 +0000 Background. Plantarflexion results from the combined action of the soleus and gastrocnemius muscles in the calf. The heel rise test is commonly used to test calf muscle endurance, function, and performance by a wide variety of professionals; however, no uniform description of the test is available. This paper aims to document the construction and reliability of a novel heel rise test device and measurement protocol that is suitable for the needs of most individuals. Methods. This device was constructed from compact and lightweight materials and is fully adjustable, enabling the testing of a wide variety of individuals. It is easy to assemble and disassemble, ensuring that it is portable for use in different settings. Findings. We tested reliability on 40 participants, finding excellent interrater reliability (ICC2,1 0.97, 95% CI: 0.94 to 0.98). Limits of agreement were less than two repetitions in 90% of cases and the Bland-Altman plot showed no bias. Interpretation. We have designed a novel, standardized, simple, and reliable device and measurement protocol for the heel rise test which can be used by researchers and clinicians in a variety of settings. Amy D. Sman, Claire E. Hiller, Adam Imer, Aldrin Ocsing, Joshua Burns, and Kathryn M. Refshauge Copyright © 2014 Amy D. Sman et al. All rights reserved. The Role of Physical Exercise in Inflammatory Bowel Disease Wed, 30 Apr 2014 08:57:08 +0000 We reviewed and analyzed the relationship between physical exercise and inflammatory bowel disease (IBD) which covers a group of chronic, relapsing, and remitting intestinal disorders including Crohn’s disease (CD) and ulcerative colitis. The etiology of IBD likely involves a combination of genetic predisposition and environmental risk factors. Physical training has been suggested to be protective against the onset of IBD, but there are inconsistencies in the findings of the published literature. Hypertrophy of the mesenteric white adipose tissue (mWAT) is recognized as a characteristic feature of CD, but its importance for the perpetuation of onset of this intestinal disease is unknown. Adipocytes synthesize proinflammatory and anti-inflammatory cytokines. Hypertrophy of mWAT could play a role as a barrier to the inflammatory process, but recent data suggest that deregulation of adipokine secretion is involved in the pathogenesis of CD. Adipocytokines and macrophage mediators perpetuate the intestinal inflammatory process, leading to mucosal ulcerations along the mesenteric border, a typical feature of CD. Contracting skeletal muscles release biologically active myokines, known to exert the direct anti-inflammatory effects, and inhibit the release of proinflammatory mediators from visceral fat. Further research is required to confirm these observations and establish exercise regimes for IBD patients. Jan Bilski, Bartosz Brzozowski, Agnieszka Mazur-Bialy, Zbigniew Sliwowski, and Tomasz Brzozowski Copyright © 2014 Jan Bilski et al. All rights reserved. Psychometric Properties of Questionnaires on Functional Health Status in Oropharyngeal Dysphagia: A Systematic Literature Review Tue, 29 Apr 2014 09:12:01 +0000 Introduction. Questionnaires on Functional Health Status (FHS) are part of the assessment of oropharyngeal dysphagia. Objective. To conduct a systematic review of the literature on the psychometric properties of English-language FHS questionnaires in adults with oropharyngeal dysphagia. Methods. A systematic search was performed using the electronic databases Pubmed and Embase. The psychometric properties of the questionnaires were determined based on the COSMIN taxonomy of measurement properties and definitions for health-related patient-reported outcomes and the COSMIN checklist using preset psychometric criteria. Results. Three questionnaires were included: the Eating Assessment Tool (EAT-10), the Swallowing Outcome after Laryngectomy (SOAL), and the Self-report Symptom Inventory. The Sydney Swallow Questionnaire (SSQ) proved to be identical to the Modified Self-report Symptom Inventory. All FHS questionnaires obtained poor overall methodological quality scores for most measurement properties. Conclusions. The retrieved FHS questionnaires need psychometric reevaluation; if the overall methodological quality shows satisfactory improvement on most measurement properties, the use of the questionnaires in daily clinic and research can be justified. However, in case of insufficient validity and/or reliability scores, new FHS questionnaires need to be developed using and reporting on preestablished psychometric criteria as recommended in literature. Renée Speyer, Reinie Cordier, Berit Kertscher, and Bas J Heijnen Copyright © 2014 Renée Speyer et al. All rights reserved. Measurement of Bed Turning and Comparison with Age, Gender, and Body Mass Index in a Healthy Population: Application of a Novel Mobility Detection System Tue, 29 Apr 2014 07:53:45 +0000 We developed a mobility detection system to analyze pressure changes over time during side-turns in 29 healthy volunteers (17 males and 12 females) with a mean age of 46.1 ± 19.64 years (ranging from 23 to 86 years) in order to determine the effect of gender, age, and BMI on performance during bed postural change. Center of gravity (COG) location, peak pressure of counteraction, and time to reach peak pressure were the main outcomes used to gauge the ability to make a spontaneous side-turn. Men exhibited significantly higher side-turning force () and back-turning force () compared with women. Subjects with BMI ≥27 kg/m2 had significantly higher side-turning force () and back-turning force () compared with those with BMI < 27 kg/m2. After adjusting for other covariates, age positively correlated with back-turning time () and negatively correlated with side-turning speed (), back-turning speed (), side-turning force (), and back-turning force (), respectively. Turning times negatively correlated with time to reach peak pressure (). Our system was effective in detecting changes in turning swiftness in the bed-ridden subject. Shang-Lin Chiang, Chia-Huei Lin, Shin-Tsu Chang, Chueh-Ho Lin, Po-Yin Chen, Wen-Hsu Sung, and Shun-Hwa Wei Copyright © 2014 Shang-Lin Chiang et al. All rights reserved. Reliability in the Parameterization of the Functional Reach Test in Elderly Stroke Patients: A Pilot Study Tue, 29 Apr 2014 07:44:45 +0000 Background. Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. Objectives. To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. Design. Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient’s back (lumbar and trunk). Participants. Five subjects over 65 who suffer from a stroke. Measurements. FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. Results. FRT measure is   cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT’s reliability was 0.987 (0.983–0.992) and 0.983 (0.979–0.989) intersubject and intrasubject, respectively. Conclusion. The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke. Jose Antonio Merchán-Baeza, Manuel González-Sánchez, and Antonio Ignacio Cuesta-Vargas Copyright © 2014 Jose Antonio Merchán-Baeza et al. All rights reserved. Motor Training in Degenerative Spinocerebellar Disease: Ataxia-Specific Improvements by Intensive Physiotherapy and Exergames Sun, 27 Apr 2014 13:45:31 +0000 The cerebellum is essentially involved in movement control and plays a critical role in motor learning. It has remained controversial whether patients with degenerative cerebellar disease benefit from high-intensity coordinative training. Moreover, it remains unclear by which training methods and mechanisms these patients might improve their motor performance. Here, we review evidence from different high-intensity training studies in patients with degenerative spinocerebellar disease. These studies demonstrate that high-intensity coordinative training might lead to a significant benefit in patients with degenerative ataxia. This training might be based either on physiotherapy or on whole-body controlled videogames (“exergames”). The benefit shown in these studies is equal to regaining one or more years of natural disease progression. In addition, first case studies indicate that even subjects with advanced neurodegeneration might benefit from such training programs. For both types of training, the observed clinical improvements are paralleled by recoveries in ataxia-specific dysfunctions (e.g., multijoint coordination and dynamic stability). Importantly, for both types of training, the retention of the effects seems to depend on the frequency and continuity of training. Based on these studies, we here present preliminary recommendations for clinical practice, and articulate open questions that might guide future studies on neurorehabilitation in degenerative spinocerebellar disease. Matthis Synofzik and Winfried Ilg Copyright © 2014 Matthis Synofzik and Winfried Ilg. All rights reserved. The Effects of High-Intensity versus Low-Intensity Resistance Training on Leg Extensor Power and Recovery of Knee Function after ACL-Reconstruction Sun, 27 Apr 2014 10:01:12 +0000 Objective. Persistent weakness is a common problem after anterior cruciate ligament- (ACL-) reconstruction. This study investigated the effects of high-intensity (HRT) versus low-intensity (LRT) resistance training on leg extensor power and recovery of knee function after ACL-reconstruction. Methods. 31 males and 19 females were randomized to HRT () or LRT () from week 8–20 after ACL-reconstruction. Leg extensor power, joint laxity, and self-reported knee function were measured before and 7, 14, and 20 weeks after surgery. Hop tests were assessed before and after 20 weeks. Results. Power in the injured leg was 90% (95% CI 86–94%) of the noninjured leg, decreasing to 64% (95% CI 60–69%) 7 weeks after surgery. During the resistance training phase there was a significant group by time interaction for power (). Power was regained more with HRT compared to LRT at week 14 (84% versus 73% of noninjured leg, resp.; ) and at week 20 (98% versus 83% of noninjured leg, resp.; ) without adverse effects on joint laxity. No other between-group differences were found. Conclusion. High-intensity resistance training during rehabilitation after ACL-reconstruction can improve muscle power without adverse effects on joint laxity. Theresa Bieler, Nanna Aue Sobol, Lars L. Andersen, Peter Kiel, Peter Løfholm, Per Aagaard, S. Peter Magnusson, Michael R. Krogsgaard, and Nina Beyer Copyright © 2014 Theresa Bieler et al. All rights reserved. Kinematic Analysis of the Upper Limb Motor Strategies in Stroke Patients as a Tool towards Advanced Neurorehabilitation Strategies: A Preliminary Study Thu, 24 Apr 2014 09:37:23 +0000 Advanced rehabilitation strategies of the upper limb in stroke patients focus on the recovery of the most important daily activities. In this study we analyzed quantitatively and qualitatively the motor strategies employed by stroke patients when reaching and drinking from a glass. We enrolled 6 hemiparetic poststroke patients and 6 healthy subjects. Motion analysis of the task proposed (reaching for the glass, bringing it to the mouth, and putting it back on the table) with the affected limb was performed. Clinical assessment using the Fugl-Meyer Assessment for Upper Extremity was also included. During the reaching for the glass the patients showed a reduced arm elongation and trunk axial rotation due to motor deficit. For this reason, as observed, they carried out compensatory strategies which included trunk forward displacement and head movements. These preliminary data should be considered to address rehabilitation treatment. Moreover, the kinematic analysis protocol developed might represent an outcome measure of upper limb rehabilitation processes. Irene Aprile, Marco Rabuffetti, Luca Padua, Enrica Di Sipio, Chiara Simbolotti, and Maurizio Ferrarin Copyright © 2014 Irene Aprile et al. All rights reserved. Efficacy of Physiotherapy for Urinary Incontinence following Prostate Cancer Surgery Thu, 24 Apr 2014 07:30:48 +0000 The study enrolled 81 with urinary incontinence following radical prostate-only prostatectomy for prostatic carcinoma. The patients were divided into two groups. The patients in Group I were additionally subdivided into two subgroups with respect to the physiotherapeutic method used. The patients of subgroup IA received a rehabilitation program consisting of three parts. The patients of subgroup IB rehabilitation program consist of two parts. Group II, a control group, had reported for therapy for persistent urinary incontinence following radical prostatectomy but had not entered therapy for personal reasons. For estimating the level of incontinence, a 1-hour and 24-hour urinary pad tests, the miction diary, and incontinence questionnaire were used, and for recording the measurements of pelvic floor muscles tension, the sEMG (surface electromyography) was applied. The therapy duration depended on the level of incontinence and it continued for not longer than 12 months. Superior continence outcomes were obtained in Group I versus Group II and the difference was statistically significant. The odds ratio for regaining continence was greater in the rehabilitated Group I and smaller in the group II without the rehabilitation. A comparison of continence outcomes revealed a statistically significant difference between Subgroups IA versus IB. The physiotherapeutic procedures applied on patients with urine incontinence after prostatectomy, for most of them, proved to be an effective way of acting, which is supported by the obtained results. Elżbieta Rajkowska-Labon, Stanisław Bakuła, Marek Kucharzewski, and Zbigniew Śliwiński Copyright © 2014 Elżbieta Rajkowska-Labon et al. All rights reserved. Robotic Upper Limb Rehabilitation after Acute Stroke by NeReBot: Evaluation of Treatment Costs Wed, 23 Apr 2014 14:43:09 +0000 Stroke is the first cause of disability. Several robotic devices have been developed for stroke rehabilitation. Robot therapy by NeReBot is demonstrated to be an effective tool for the treatment of poststroke paretic upper limbs, able to improve the activities of daily living of stroke survivors when used both as additional treatment and in partial substitution of conventional rehabilitation therapy in the acute and subacute phases poststroke. This study presents the evaluation of the costs related to delivering such therapy, in comparison with conventional rehabilitation treatment. By comparing several NeReBot treatment protocols, made of different combinations of robotic and nonrobotic exercises, we show that robotic technology can be a valuable and economically sustainable aid in the management of poststroke patient rehabilitation. Masiero Stefano, Poli Patrizia, Armani Mario, Gregorio Ferlini, Roberto Rizzello, and Giulio Rosati Copyright © 2014 Masiero Stefano et al. All rights reserved. Gait Patterns in Hemiplegic Patients with Equinus Foot Deformity Tue, 22 Apr 2014 13:39:45 +0000 Equinus deformity of the foot is a common feature of hemiplegia, which impairs the gait pattern of patients. The aim of the present study was to explore the role of ankle-foot deformity in gait impairment. A hierarchical cluster analysis was used to classify the gait patterns of 49 chronic hemiplegic patients with equinus deformity of the foot, based on temporal-distance parameters and joint kinematic measures obtained by an innovative protocol for motion assessment in the sagittal, frontal, and transverse planes, synthesized by parametrical analysis. Cluster analysis identified five subgroups of patients with homogenous levels of dysfunction during gait. Specific joint kinematic abnormalities were found, according to the speed of progression in each cluster. Patients with faster walking were those with less ankle-foot complex impairment or with reduced range of motion of ankle-foot complex, that is with a stiff ankle-foot complex. Slow walking was typical of patients with ankle-foot complex instability (i.e., larger motion in all the planes), severe equinus and hip internal rotation pattern, and patients with hip external rotation pattern. Clustering of gait patterns in these patients is helpful for a better understanding of dysfunction during gait and delivering more targeted treatment. M. Manca, G. Ferraresi, M. Cosma, L. Cavazzuti, M. Morelli, and M. G. Benedetti Copyright © 2014 M. Manca et al. All rights reserved. Telerehabilitation in Poststroke Anomia Tue, 15 Apr 2014 14:08:58 +0000 Anomia, a word-finding difficulty, is a frequent consequence of poststroke linguistic disturbance, associated with fluent and nonfluent aphasia that needs long-term specific and intensive speech rehabilitation. The present study explored the feasibility of telerehabilitation as compared to a conventional face-to-face treatment of naming, in patients with poststroke anomia. Five aphasic chronic patients participated in this study characterized by: strictly controlled crossover design; well-balanced lists of words in picture-naming tasks where progressive phonological cues were provided; same kind of the treatment in the two ways of administration. ANOVA was used to compare naming accuracy in the two types of treatment, at three time points: baseline, after treatment, and followup. The results revealed no main effect of treatment type () indicating that face-to-face and tele-treatment yielded comparable results. Moreover, there was a significant main effect of time () due to a better performance immediately after treatment and in the followup when comparing them to baseline. These preliminary results show the feasibility of teletreatment applied to lexical deficits in chronic stroke patients, extending previous work on telerehabilitation and opening new vistas for future studies on teletreatment of language functions. Michela Agostini, Martina Garzon, Silvia Benavides-Varela, Serena De Pellegrin, Giulia Bencini, Giulia Rossi, Sara Rosadoni, Mauro Mancuso, Andrea Turolla, Francesca Meneghello, and Paolo Tonin Copyright © 2014 Michela Agostini et al. All rights reserved. Comparing the Activity Profiles of Wheelchair Rugby Using a Miniaturised Data Logger and Radio-Frequency Tracking System Tue, 15 Apr 2014 14:03:43 +0000 The current study assessed the validity and reliability of a miniaturised data logger (MDL) against a radio-frequency-based indoor tracking system (ITS) for quantifying key aspects of mobility performance during wheelchair rugby. Eleven international wheelchair rugby players were monitored by both devices during four wheelchair rugby matches. MDL data were averaged over both 1-second (MDL-1) and 5-second (MDL-5) intervals to calculate distance, mean, and peak speeds. The results revealed no significant differences between devices for the distance covered or mean speeds, although random errors of 10% and 12%, respectively, were identified in relation to the mean values. No significant differences in peak speed were revealed between ITS ( m·s−1) and MDL-1 ( m·s−1). Whereas peak speeds in MDL-5 ( m·s−1) were significantly lower than ITS. Errors in peak speed led to large random errors in time and distance spent in speed zones relative to peak speed, especially in MDL-5. The current study revealed that MDL provide a reasonable representation of the distance and mean speed reported during wheelchair rugby. However, inaccuracy in the detection of peak speeds limits its use for monitoring performance and prescribing wheelchair rugby training programmes. Barry Mason, John Lenton, James Rhodes, Rory Cooper, and Victoria Goosey-Tolfrey Copyright © 2014 Barry Mason et al. All rights reserved. Lateralization of Motor Cortex Excitability in Stroke Patients during Action Observation: A TMS Study Mon, 14 Apr 2014 07:32:30 +0000 Action observation activates the same motor areas as those involved in the performance of the observed actions and promotes functional recovery following stroke. Movement observation is now considered a promising tool for motor rehabilitation, by allowing patients to train their motor functions when voluntary movement is partially impaired. We asked chronic-stroke patients, affected by either left (LHD) or right hemisphere (RHD) lesions, to observe either a left or right hand, while grasping a small target (eliciting a precision grip) or a large target (eliciting a whole hand grasp directed towards a target object). To better understand the effects of action observation on damaged motor circuits, we used transcranial magnetic stimulation (TMS) to induce motor evoked potentials (MEP) from two muscles of the unaffected hand in 10 completely hemiplegic participants. Results revealed that LHD patients showed MEP facilitation on the right (contralesional) M1 during action observation of hand-object interactions. In contrast, results showed no facilitation of the left (contralesional) M1 in RHD patients. Our results confirm that action observation might have a positive influence on the recovery of motor functions after stroke. Activating the motor system by means of action observation might provide a mechanism for improving function, at least in LHD patients. Mattia Marangon, Konstantinos Priftis, Marta Fedeli, Stefano Masiero, Paolo Tonin, and Francesco Piccione Copyright © 2014 Mattia Marangon et al. All rights reserved. High-Intensity Intermittent Swimming Improves Cardiovascular Health Status for Women with Mild Hypertension Thu, 10 Apr 2014 09:08:47 +0000 To test the hypothesis that high-intensity swim training improves cardiovascular health status in sedentary premenopausal women with mild hypertension, sixty-two women were randomized into high-intensity (; HIT), moderate-intensity (; MOD), and control groups (; CON). HIT performed 6–10 × 30 s all-out swimming interspersed by 2 min recovery and MOD swam continuously for 1 h at moderate intensity for a 15-week period completing in total and sessions, respectively. In CON, all measured variables were similar before and after the intervention period. Systolic BP decreased () by and  mmHg in HIT and MOD; respectively. Resting heart rate declined () by bpm both in HIT and MOD, fat mass decreased () by and  kg, respectively, while the blood lipid profile was unaltered. In HIT and MOD, performance improved () for a maximal 10 min swim (% and %), interval swimming (% and %), and Yo-Yo IE1 running performance (% and %). In conclusion, high-intensity intermittent swimming is an effective training strategy to improve cardiovascular health and physical performance in sedentary women with mild hypertension. Adaptations are similar with high- and moderate-intensity training, despite markedly less total time spent and distance covered in the high-intensity group. Magni Mohr, Nikolai Baastrup Nordsborg, Annika Lindenskov, Hildigunn Steinholm, Hans Petur Nielsen, Jann Mortensen, Pal Weihe, and Peter Krustrup Copyright © 2014 Magni Mohr et al. All rights reserved. Angular Velocity Affects Trunk Muscle Strength and EMG Activation during Isokinetic Axial Rotation Tue, 08 Apr 2014 08:49:58 +0000 Objective. To evaluate trunk muscle strength and EMG activation during isokinetic axial rotation at different angular velocities. Method. Twenty-four healthy young men performed isokinetic axial rotation in right and left directions at 30, 60, and 120 degrees per second angular velocity. Simultaneously, surface EMG was recorded on external oblique (EO), internal oblique (IO), and latissimus dorsi (LD) bilaterally. Results. In each direction, with the increase of angular velocity, peak torque decreased, whereas peak power increased. During isokinetic axial rotation, contralateral EO as well as ipsilateral IO and LD acted as primary agonists, whereas, ipsilateral EO as well as contralateral IO and LD acted as primary antagonistic muscles. For each primary agonist, the root mean square values decreased with the increase of angular velocity. Antagonist coactiviation was observed at each velocity; however, it appears to be higher with the increase of angular velocity. Conclusion. Our results suggest that velocity of rotation has great impact on the axial rotation torque and EMG activity. An inverse relationship of angular velocity was suggested with the axial rotation torque as well as root mean square value of individual trunk muscle. In addition, higher velocity is associated with higher coactivation of antagonist, leading to a decrease in torque with the increase of velocity. Jian-Zhong Fan, Xia Liu, and Guo-Xin Ni Copyright © 2014 Jian-Zhong Fan et al. All rights reserved. Resistance Training and Testosterone Levels in Male Patients with Chronic Kidney Disease Undergoing Dialysis Thu, 03 Apr 2014 13:06:57 +0000 Background. We investigated serum testosterone and insulin-like growth factor 1 (IGF-1) levels’ associations with muscle fibre size and resistance training in male dialysis patients. Methods. Male patients were included in a 16-week control period followed by 16 weeks of resistance training thrice weekly. Blood samples were obtained to analyse testosterone, luteinizing hormone (LH), IGF-1, and IGF-binding protein 3. Muscle fibres’ size was analysed in biopsies from m. vastus lateralis. Results. The patients’ testosterone levels were within the normal range at baseline () (19.5 (8.2–52.1) nmol/L versus 17.6 (16.1–18.0), resp.) whereas LH levels were higher (13.0 (5.5–82.8) U/L versus 4.3 (3.3–4.6), , resp.). IGF-1 and IGF-binding protein 3 levels were higher in the patients compared with reference values (203 (59–590) ng/mL versus 151 (128–276), , and 5045 (3370–9370) ng/mL versus 3244 (3020–3983), , resp.). All hormone levels and muscle fibre size () remained stable throughout the study. Age-adjusted IGF-1 was associated with type 1 and 2 fibre sizes (). Conclusion. Patients’ total testosterone values were normal due to markedly increased LH values, which suggest a compensated primary insufficiency of the testosterone producing Leydig cell. Even though testosterone values were normal, resistance training was not associated with muscle hypertrophy. This trial is registered with ISRCTN72099857. Stig Molsted, Jesper L. Andersen, Inge Eidemak, Adrian P. Harrison, and Niels Jørgensen Copyright © 2014 Stig Molsted et al. All rights reserved. Resistance Exercise with Older Fallers: Its Impact on Intermuscular Adipose Tissue Thu, 03 Apr 2014 07:05:51 +0000 Objective. Greater skeletal muscle fat infiltration occurs with age and contributes to numerous negative health outcomes. The primary purpose was to determine whether intermuscular adipose tissue (IMAT) can be influenced by an exercise intervention and if a greater reduction in IMAT occurs with eccentric versus traditional resistance training. Methods. Seventy-seven older adults (age 75.5 ± 6.8) with multiple comorbidities and a history of falling completed a three-month exercise intervention paired with either eccentric or traditional resistance training. MRI of the mid-thigh was examined at three time points to determine changes in muscle composition after intervention. Results. No differences in IMAT were observed over time, and there were no differences in IMAT response between intervention groups. Participants in the traditional group lost a significant amount of lean tissue () in the nine months after intervention, while participants in the eccentric group did not (). When IMAT levels were partitioned into high and low IMAT groups, there were differential IMAT responses to intervention with the high group lowering thigh IMAT. Conclusions. There is no decrease in thigh IMAT after a three-month exercise intervention in older adults at risk for falling and no benefit to eccentric training over traditional resistance training for reducing IMAT in these individuals. Janelle L. Jacobs, Robin L. Marcus, Glen Morrell, and Paul LaStayo Copyright © 2014 Janelle L. Jacobs et al. All rights reserved. Interleukin-6 and Vitamin D Status during High-Intensity Resistance Training in Patients with Chronic Kidney Disease Wed, 02 Apr 2014 12:45:02 +0000 Background. The aim of this study was to investigate IL-6 and 25-hydroxyvitamin D (25-OH D) associations with muscle size and muscle function in dialysis patients. Methods. Patients were included in a 16-week control period followed by 16 weeks of high-intensity resistance training thrice weekly. IL-6 and 25-OH D were analysed after an over-night fast. Muscle fibre size was analysed in biopsies from m. vastus lateralis. Muscle power was tested using a Leg Extensor Power Rig. Results. Patients () with IL-6 ≥ 6.49 pg/ml (median) were older and had decreased muscle power and a reduced protein intake () compared with patients with IL-6 < 6.49 pg/ml. IL-6 was not associated with muscle fibre size. Vitamin D deficiency (25-OH D < 50 nmol/l) was present in 51% of the patients and not associated with muscle power. IL-6 remained unchanged during the training period, whilst muscle power increased by 20–23% (). Conclusion. Elevated IL-6 values were associated with decreased muscle power but not with decreased muscle fibre size. Half of the patients were suffering from vitamin D deficiency, which was not associated with muscle power. IL-6 was unchanged by high-intensity resistance training in dialysis patients in this study. Stig Molsted, Pia Eiken, Jesper L. Andersen, Inge Eidemak, and Adrian P. Harrison Copyright © 2014 Stig Molsted et al. All rights reserved. Formetric 4D Rasterstereography Mon, 31 Mar 2014 08:02:36 +0000 Johnny Padulo and Luca Paolo Ardigò Copyright © 2014 Johnny Padulo and Luca Paolo Ardigò. All rights reserved. The Long-Term Prognostic Significance of 6-Minute Walk Test Distance in Patients with Chronic Heart Failure Thu, 27 Mar 2014 08:08:24 +0000 Background. The 6-minute walk test (6-MWT) is used to assess patients with chronic heart failure (CHF). The prognostic significance of the 6-MWT distance during long-term followup (>5 years) is unclear. Methods. 1,667 patients (median [inter-quartile range, IQR]) (age 72 [65–77]; 75% males) with heart failure due to left ventricular systolic impairment undertook a 6-MWT as part of their baseline assessment and were followed up for 5 years. Results. At 5 years’ followup, those patients who died (n = 959) were older at baseline and had a higher log NT pro-BNP than those who survived to 5 years (n = 708). 6-MWT distance was lower in those who died [163 (153) m versus 269 (160) m; P < 0.0001]. Median 6-MWT distance was 300 (150–376) m, and quartile ranges were <46 m, 46–240 m, 241–360 m, and >360 m. 6-MWT distance was a predictor of all-cause mortality (HR 0.97; 95% CI 0.96-0.97; Chi-square = 184.1; P < 0.0001). Independent predictors of all-cause mortality were decreasing 6-MWT distance, increasing age, increasing NYHA classification, increasing log NT pro-BNP, decreasing diastolic blood pressure, decreasing sodium, and increasing urea. Conclusion. The 6-MWT is an important independent predictor of all-cause mortality following long-term followup in patients with CHF. Lee Ingle, John G. Cleland, and Andrew L. Clark Copyright © 2014 Lee Ingle et al. All rights reserved. Change of Muscle Architecture following Body Weight Support Treadmill Training for Persons after Subacute Stroke: Evidence from Ultrasonography Mon, 24 Mar 2014 07:40:28 +0000 Although the body weight support treadmill training (BWSTT) in rehabilitation therapy has been appreciated for a long time, the biomechanical effects of this training on muscular system remain unclear. Ultrasonography has been suggested to be a feasible method to measure muscle morphological changes after neurological diseases such as stroke, which may help to enhance the understanding of the mechanism underlying the impaired motor function. This study investigated the muscle architectural changes of tibialis anterior and medial gastrocnemius in patients after subacute stroke by ultrasound. As expected, we found the effect of BWSTT on the muscular system. Specifically, the results showed larger pennation angle and muscle thickness of tibialis anterior and longer fascicle length of medial gastrocnemius after the training. The findings of this study suggest that the early rehabilitation training of BWSTT in subacute stage of stroke provides positive changes of the muscle architecture, leading to the potential improvement of the force generation of the muscle. This may not only help us understand changes of subacute stroke in muscular system but also have clinical implications in the evaluation of rehabilitation training after neurological insults. Peng Liu, Yanjun Wang, Huijing Hu, Yurong Mao, Dongfeng Huang, and Le Li Copyright © 2014 Peng Liu et al. All rights reserved. The Effect of Bolus Volume on Hyoid Kinematics in Healthy Swallowing Sun, 23 Mar 2014 14:55:38 +0000 Hyoid movement in swallowing is biomechanically linked to closure of the laryngeal vestibule for airway protection and to opening of the upper esophageal sphincter. Studies suggest that the range of hyoid movement is highly variable in the healthy population. However, other aspects of hyoid movement such as velocity remain relatively unexplored. In this study, we analyze data from a sample of 20 healthy young participants (10 male) to determine whether hyoid movement distance, duration, velocity, and peak velocity vary systematically with increases in thin liquid bolus volume from 5 to 20 mL. The temporal correspondence between peak hyoid velocity and laryngeal vestibule closure was also examined. The results show that maximum hyoid position and peak velocity increase significantly for 20 mL bolus volumes compared to smaller volumes, and that the timing of peak velocity is closely linked to achieving laryngeal vestibule closure. This suggests that generating hyoid movements with increased power is a strategy for handling larger volumes. Ahmed Nagy, Sonja M. Molfenter, Melanie Péladeau-Pigeon, Shauna Stokely, and Catriona M. Steele Copyright © 2014 Ahmed Nagy et al. All rights reserved. The Role of the Extracellular Matrix Components in Cutaneous Wound Healing Mon, 17 Mar 2014 16:24:52 +0000 Wound healing is the physiologic response to tissue trauma proceeding as a complex pathway of biochemical reactions and cellular events, secreted growth factors, and cytokines. Extracellular matrix constituents are essential components of the wound repair phenomenon. Firstly, they create a provisional matrix, providing a structural integrity of matrix during each stage of healing process. Secondly, matrix molecules regulate cellular functions, mediate the cell-cell and cell-matrix interactions, and serve as a reservoir and modulator of cytokines and growth factors’ action. Currently known mechanisms, by which extracellular matrix components modulate each stage of the process of soft tissue remodeling after injury, have been discussed. Pawel Olczyk, Łukasz Mencner, and Katarzyna Komosinska-Vassev Copyright © 2014 Pawel Olczyk et al. All rights reserved. Physical Performance Is Associated with Working Memory in Older People with Mild to Severe Cognitive Impairment Sun, 16 Mar 2014 12:30:37 +0000 Background. Physical performances and cognition are positively related in cognitively healthy people. The aim of this study was to examine whether physical performances are related to specific cognitive functioning in older people with mild to severe cognitive impairment. Methods. This cross-sectional study included 134 people with a mild to severe cognitive impairment (mean age 82 years). Multiple linear regression was performed, after controlling for covariates and the level of global cognition, with the performances on mobility, strength, aerobic fitness, and balance as predictors and working memory and episodic memory as dependent variables. Results. The full models explain 49–57% of the variance in working memory and 40–43% of episodic memory. Strength, aerobic fitness, and balance are significantly associated with working memory, explaining 3–7% of its variance, irrespective of the severity of the cognitive impairment. Physical performance is not related to episodic memory in older people with mild to severe cognitive impairment. Conclusions. Physical performance is associated with working memory in older people with cognitive impairment. Future studies should investigate whether physical exercise for increased physical performance can improve cognitive functioning. This trial is registered with NTR1482. K. M. Volkers and E. J. A. Scherder Copyright © 2014 K. M. Volkers and E. J. A. Scherder. All rights reserved. Tension-Free Vaginal Tape, Transobturator Tape, and Own Modification of Transobturator Tape in the Treatment of Female Stress Urinary Incontinence: Comparative Analysis Sun, 16 Mar 2014 10:02:20 +0000 Introduction. This study is a comparative evaluation of the TVT, TOT, and our own modification of TOT (mTOT) in the treatment of female stress urinary incontinence from a single center experience. Material and Methods. The study was conducted on 527 patients with SUI diagnosed on the basis of urodynamic studies. They were divided into three groups—TVT: , (TOT): , and mTOT: . All of the patients underwent evaluation at 1, 3, and 6 months after surgery. Results were statistically analysed and compared. Results. Objective and subjective effectiveness after the surgery were not significantly different in the study groups and ranged from 90.1% to 96.4%. Mean surgery time was 32.3, 28.2, and 26.4 in the TVT, TOT, and mTOT, respectively. Mean hospitalization time was 2.51 days. Mean catheter maintenance time was significantly higher in the TVT than in other groups. In the TVT group total incidence of complications was 13.4%, and it was significantly higher than that in TOT and mTOT (9.3% and 8.6%, resp.). Conclusions. TVT, TOT, and mTOT are highly effective and safe methods in the treatment of SUI. There are no differences in the efficacy between the methods with a little higher percentage of complications in the TVT group. Marcin Zyczkowski, Krzysztof Nowakowski, Waclaw Kuczmik, Tomasz Urbanek, Zbiegniew Kaletka, Piotr Bryniarski, Bartosz Muskala, and Andrzej Paradysz Copyright © 2014 Marcin Zyczkowski et al. All rights reserved. Reliability of a Simple Physical Therapist Screening Tool to Assess Errors during Resistance Exercises for Musculoskeletal Pain Thu, 13 Mar 2014 08:32:12 +0000 The main objective was to investigate the intra- and intertester reliability of a simple screening tool assessing errors in exercise execution by visual observation. 38 participants with no previous resistance exercise experience practiced for two weeks four typical upper limb exercises using elastic tubing. At 2-week follow-up, the participants were invited for a test-retest assessment on errors in technical execution. The assessment was based on ordinal deviation of joint position from neutral of the shoulder, elbow, and wrist in a single plane by visual observation. Moderate intratester reliability weighted kappa (w) score ranging from 0.50 (0.21–0.71) to 0.57 (0.24–0.82) for observer 1 and a fair to moderate intratester reliability w score ranging from 0.27 (0.09–0.43) to 0.52 (0.15–0.86) for observer 2 across the four exercises was observed. For intertester reliability moderate to substantial mean w scores were found between the two observers, slightly improving from round one to round two ranging from 0.40 (0.20–0.59) to 0.68 (0.45–0.91) in round one to 0.52 (0.20–0.80) to 0.69 (0.39–0.86) in round two. The exercise error assessment demonstrated fair to substantial intratester and intertester reliability, which is congruent with previously published studies. Hence the simplicity of defining a neutral joint position for each of the involved joints in the exercise and categorizing the deviation in “some deviation” and “substantial deviation” to either side in a single plane is a viable and inexpensive solution when assessing for errors during exercise. Kenneth Jay, Emil Sundstrup, and Lars L. Andersen Copyright © 2014 Kenneth Jay et al. All rights reserved. Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial Thu, 13 Mar 2014 06:39:55 +0000 Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic). Design. Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE () and TR (), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak). Results. The F-M UE (), FIM (), time (), and peak (), were significantly higher in the RFVE group after treatment, but not speed (). The patients affected by hemorrhagic stroke significantly improved FIM (), time (), and peak () after treatment, whereas the patients affected by ischemic stroke improved significantly only speed () when treated by RFVE. Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291. Paweł Kiper, Michela Agostini, Carlos Luque-Moreno, Paolo Tonin, and Andrea Turolla Copyright © 2014 Paweł Kiper et al. All rights reserved. High versus Moderate Intensity Running Exercise to Impact Cardiometabolic Risk Factors: The Randomized Controlled RUSH-Study Tue, 11 Mar 2014 13:07:58 +0000 Aerobic exercise positively impacts cardiometabolic risk factors and diseases; however, the most effective exercise training strategies have yet to be identified. To determine the effect of high intensity (interval) training (HI(I)T) versus moderate intensity continuous exercise (MICE) training on cardiometabolic risk factors and cardiorespiratory fitness we conducted a 16-week crossover RCT with partial blinding. Eighty-one healthy untrained middle-aged males were randomly assigned to two study arms: (1) a HI(I)T-group and (2) a sedentary control/MICE-group that started their MICE protocol after their control status. HI(I)T focused on interval training (90 sec to 12 min >85–97.5% HRmax) intermitted by active recovery (1–3 min at 65–70% HRmax), while MICE consisted of continuous running at 65–75% HRmax. Both exercise groups progressively performed 2–4 running sessions/week of 35 to 90 min/session; however, protocols were adjusted to attain similar total work (i.e., isocaloric conditions). With respect to cardiometabolic risk factors and cardiorespiratory fitness both exercise groups demonstrated similar significant positive effects on MetS-Z-Score (HI(I)T: , versus MICE: , ) and (relative) VO2max (HI(I)T: %, versus MICE: 10.6 ± 9.6%, ) compared with the sedentary control group. In conclusion, both exercise programs were comparably effective for improving cardiometabolic indices and cardiorespiratory fitness in untrained middle-aged males. Wolfgang Kemmler, Michael Scharf, Michael Lell, Carina Petrasek, and Simon von Stengel Copyright © 2014 Wolfgang Kemmler et al. All rights reserved. Propolis Modulates Fibronectin Expression in the Matrix of Thermal Injury Tue, 11 Mar 2014 12:22:52 +0000 The aim of the study was to assess the propolis effect on fibronectin metabolism in the course of burn wounds healing process. A model of burn wound healing of pig skin was applied. The amount of the released glycoprotein was assessed by a surface plasmon resonance. The profile of extracted fibronectin components was also assessed by an electrophoresis in polyacrylamide gel, with a subsequent immunodetection by Western Blotting. Propolis burn treatment decreased the release of fibronectin components from healing wounds in relation to damages treated with silver sulfadiazine. The main reason of decreased extraction of fibronectin components from wounds treated with propolis was a substantial decrease of degradation product release of the mentioned glycoprotein, which was observed particularly from the 3rd to 5th day of the repair. Wounds treatment with propolis demonstrated, especially in relation to damages treated with silver sulfadiazine, the decreased release of synthesized fibronectin molecules. The obtained results suggest that propolis modifies fibronectin metabolism in the course of wound healing process. The influence of propolis is reflected in prevention of fibronectin biosynthesis as well as its degradation in the wound area. The above-mentioned metabolic changes may decrease the risk of complications in the repair wounds process. Pawel Olczyk, Katarzyna Komosinska-Vassev, Grzegorz Wisowski, Lukasz Mencner, Jerzy Stojko, and Ewa M. Kozma Copyright © 2014 Pawel Olczyk et al. All rights reserved. Optogenetic Activation of the Excitatory Neurons Expressing CaMKIIα in the Ventral Tegmental Area Upregulates the Locomotor Activity of Free Behaving Rats Mon, 10 Mar 2014 12:26:40 +0000 The ventral tegmental area (VTA) plays an important role in motivation and motor activity of mammals. Previous studies have reported that electrical stimulations of the VTA’s neuronal projections were able to upregulate the locomotor activity of behaving rats. However, which types of neurons in the VTA that take part in the activation remain elusive. In this paper we employed optogenetic technique to selectively activate the excitatory neurons expressing CaMKIIα in the VTA region and induced a higher locomotor activity for free behaving rats. Further behavioral studies indicated that reward learning mediated in the enhancement of the rat locomotor activity. Finally the immunohistochemistry studies explored that the excitatory neurons under the optogenetic activation in VTA were partly dopaminergic that may participate as a vital role in the optogenetic activation of the locomotor activity. In total, our study provided an optogenetic approach to selectively upregulate the locomotor activity of free behaving rats, thus facilitating both neuroscience researches and neural engineering such as animal robotics in the future. Songchao Guo, Sicong Chen, Qiaosheng Zhang, Yueming Wang, Kedi Xu, and Xiaoxiang Zheng Copyright © 2014 Songchao Guo et al. All rights reserved. Effect of Video-Based versus Personalized Instruction on Errors during Elastic Tubing Exercises for Musculoskeletal Pain: A Randomized Controlled Trial Mon, 10 Mar 2014 10:30:16 +0000 Workplace interventions have shown beneficial results of resistance training for chronic pain in the neck, shoulder, and arm. However, studies have relied on experienced exercise instructors, which may not be an available resource at most workplaces. The objective of this study is to evaluate the technical performance level of upper limb rehabilitation exercises following video-based versus personalized exercise instruction. We recruited 38 laboratory technicians and office workers with neck/shoulder pain for a two-week exercise training period receiving either (1) personal and video or (2) video only instruction in four typical neck/shoulder/arm rehabilitation exercises using elastic tubing. At a 2-week follow-up, the participants’ technical execution was assessed by two blinded physical therapists using a reliable error assessment tool. The error assessment was based on ordinal deviation of joint position from the ideal position of the shoulder, elbow, and wrist in a single plane by visual observation. Of the four exercises only unilateral shoulder external rotation had a higher normalized error score in the V group of 22.19 (9.30) to 12.64 (6.94) in the P group (). For the remaining three exercises the normalized error score did not differ. In conclusion, when instructing simple exercises to reduce musculoskeletal pain the use of video material is a cost-effective solution that can be implemented easily in corporations with challenging work schedules not allowing for a fixed time of day to go see a personal trainer. Kenneth Jay, m. c. schraefel, Mikkel Brandt, and Lars L. Andersen Copyright © 2014 Kenneth Jay et al. All rights reserved. Lasting Effects of Workplace Strength Training for Neck/Shoulder/Arm Pain among Laboratory Technicians: Natural Experiment with 3-Year Follow-Up Mon, 10 Mar 2014 09:16:39 +0000 Objectives. This study investigated long-term effects and implementation processes of workplace strength training for musculoskeletal disorders. Methods. 333 and 140 laboratory technicians from private and public sector companies, respectively, replied to a 3-year follow-up questionnaire subsequent to a 1-year randomized controlled trial (RCT) with high-intensity strength training for prevention and treatment of neck, shoulder, and arm pain. Being a natural experiment, the two participating companies implemented and modified the initial training program in different ways during the subsequent 2 years after the RCT. Results. At 3-year follow-up the pain reduction in neck, shoulder, elbow, and wrist achieved during the first year was largely maintained at both companies. However, the private sector company was rated significantly better than the public sector company in (1) training adherence, (2) training culture, that is, relatively more employees trained at the workplace and with colleagues, (3) self-reported health changes, and (4) prevention of neck and wrist pain development among initially pain-free employees. Conclusions. This natural experiment shows that strength training can be implemented successfully at different companies during working hours on a long-term basis with lasting effects on pain in neck, shoulder, and arm. Peter Mortensen, Anders I. Larsen, Mette K. Zebis, Mogens T. Pedersen, Gisela Sjøgaard, and Lars L. Andersen Copyright © 2014 Peter Mortensen et al. All rights reserved. High-Intensity Interval Training in Patients with Substance Use Disorder Sun, 02 Mar 2014 13:37:01 +0000 Patients with substance use disorder (SUD) suffer a higher risk of cardiovascular disease and other lifestyle diseases compared to the general population. High intensity training has been shown to effectively reduce this risk, and therefore we aimed to examine the feasibility and effect of such training in SUD patients in clinical treatment in the present study. 17 males and 7 females (32 ± 8 yr) in treatment were randomized to either a training group (TG), treadmill interval training in 4 × 4 minutes at 90–95% of maximal heart rate, 3 days a week for 8 weeks, or a conventional rehabilitation control group (CG). Baseline values for both groups combined at inclusion were 44 ± 8 (males) and 34 ± 9 (females) mL · min−1 · kg−1, respectively. 9/12 and 7/12 patients completed the TG and CG, respectively. Only the TG significantly improved (15 ± 7%) their maximal oxygen consumption (V), from 42.3 ± 7.2 mL · min−1 · kg−1 at pretest to 48.7 ± 9.2 mL · min−1 · kg−1 at posttest. No between-group differences were observed in work economy, and level of insomnia (ISI) or anxiety and depression (HAD), but a significant within-group improvement in depression was apparent for the TG. High intensity training was feasible for SUD patients in treatment. This training form should be implemented as a part of the rehabilitation since it, in contrast to the conventional treatment, represents a risk reduction for cardiovascular disease and premature death. Grete Flemmen, Runar Unhjem, and Eivind Wang Copyright © 2014 Grete Flemmen et al. All rights reserved. The Effect of a Short-Term High-Intensity Circuit Training Program on Work Capacity, Body Composition, and Blood Profiles in Sedentary Obese Men: A Pilot Study Sun, 23 Feb 2014 13:57:07 +0000 The objective of this study was to determine how a high-intensity circuit-training (HICT) program affects key physiological health markers in sedentary obese men. Eight obese (body fat percentage %) males completed a four-week HICT program, consisting of three 30-minute exercise sessions per week, for a total of 6 hours of exercise. Participants’ heart rate (HR), blood pressure (BP), rating of perceived exertion, total work (TW), and time to completion were measured each exercise session, body composition was measured before and after HICT, and fasting blood samples were measured before throughout, and after HICT program. Blood sample measurements included total cholesterol, triacylglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glucose, and insulin. Data were analyzed by paired t-tests and one-way ANOVA with repeated measures. Statistical significance was set to . Data analyses revealed significant () improvements in resting HR (16% decrease), systolic BP (5.5% decrease), TW (50.7%), fat tissue percentage (3.6%), lean muscle tissue percentage (2%), cholesterol (13%), triacylglycerol (37%), and insulin (18%) levels from before to after HICT program. Overall, sedentary obese males experienced a significant improvement in biochemical, physical, and body composition characteristics from a HICT program that was only 6 hours of the total exercise. Matthew B. Miller, Gregory E. P. Pearcey, Farrell Cahill, Heather McCarthy, Shane B. D. Stratton, Jennifer C. Noftall, Steven Buckle, Fabien A. Basset, Guang Sun, and Duane C. Button Copyright © 2014 Matthew B. Miller et al. All rights reserved. High-Intensity Strength Training Improves Function of Chronically Painful Muscles: Case-Control and RCT Studies Sun, 23 Feb 2014 07:51:34 +0000 Aim. This study investigates consequences of chronic neck pain on muscle function and the rehabilitating effects of contrasting interventions. Methods. Women with trapezius myalgia (MYA, ) and healthy controls (CON, ) participated in a case-control study. Subsequently MYA were randomized to 10 weeks of specific strength training (SST, ), general fitness training (GFT, ), or a reference group without physical training (REF, ). Participants performed tests of 100 consecutive cycles of 2 s isometric maximal voluntary contractions (MVC) of shoulder elevation followed by 2 s relaxation at baseline and 10-week follow-up. Results. In the case-control study, peak force, rate of force development, and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all 100 MVC. Muscle fiber capillarization was not significantly different between MYA and CON. In the intervention study, SST improved all force parameters significantly more than the two other groups, to levels comparable to that of CON. This was seen along with muscle fiber hypertrophy and increased capillarization. Conclusion. Women with trapezius myalgia have lower strength capacity during repetitive MVC of the trapezius muscle than healthy controls. High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle. Lars L. Andersen, Christoffer H. Andersen, Jørgen H. Skotte, Charlotte Suetta, Karen Søgaard, Bengt Saltin, and Gisela Sjøgaard Copyright © 2014 Lars L. Andersen et al. All rights reserved. Evaluation of Bioelectrical Activity of Pelvic Floor Muscles and Synergistic Muscles Depending on Orientation of Pelvis in Menopausal Women with Symptoms of Stress Urinary Incontinence: A Preliminary Observational Study Wed, 19 Feb 2014 10:00:53 +0000 Objectives. Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles (PFM) and the synergistic muscles, depending on the orientation of the pelvis, in anterior (P1) and posterior (P2) pelvic tilt. Design. Preliminary, prospective observational study. Setting. Department and Clinic of Urology, University Hospital in Wroclaw, Poland. Participants. Thirty-two menopausal and postmenopausal women with stress urinary incontinence were recruited. Based on inclusion and exclusion criteria, sixteen women aged 55 to 70 years were enrolled in the study. Primary Outcome Measures. Evaluation of resting and functional bioelectrical activity of the pelvic floor muscles by electromyography (sEMG) and vaginal probe. Secondary Outcome Measures. Evaluation of activity of the synergistic muscles by sEMG and surface electrodes. Results. No significant differences between orientations P1 and P2 were found in functional and resting sEMG activity of the PFM. During resting and functional PFM activity, higher electrical activity in P2 than in P1 has been recorded in some of the synergistic muscles. Conclusions. This preliminary study does not provide initial evidence that pelvic tilt influences PFM activation. Although different activity of synergistic muscles occurs in various orientations of the pelvic tilt, it does not have to affect the sEMG activity of the PFM. Tomasz Halski, Lucyna Słupska, Robert Dymarek, Janusz Bartnicki, Urszula Halska, Agata Król, Małgorzata Paprocka-Borowicz, Janusz Dembowski, Romuald Zdrojowy, and Kuba Ptaszkowski Copyright © 2014 Tomasz Halski et al. All rights reserved. A Pilot Study of Partial Unweighted Treadmill Training in Mobility-Impaired Older Adults Wed, 19 Feb 2014 07:31:25 +0000 Background. Partial unweighted treadmill training is a potentially effective modality for improving fitness and function in frail elders. We tested the feasibility of partial unweighted treadmill training in older, mobility-impaired veterans. Methods. Eight mobility-impaired elders participated in partial unweighted treadmill training three times/week for twelve weeks. Outcome measures included gait speed, performance-oriented mobility assessment (POMA), eight foot up and go, and the SF-36 physical functioning short form. Results. There was significant improvement in treadmill walking time (+8.5 minutes; ), treadmill walking speed (+0.14 meters/second; ), and percent of body weight support (−2.2%; ). Changes in physical performance included usual gait speed (+0.12 meters/second; ), rapid gait speed (+0.13 meters/second; ), POMA (+2.4 summary score; ), and eight foot up and go (−1.2 seconds; ). Conclusions. Partial unweighted treadmill training is feasible in mobility-impaired elders. Improvements in treadmill training capacity resulted in clinically meaningful improvements in fitness levels and improved mobility. Matthew J. Peterson, Nanyamka Williams, Kevin Caves, and Miriam C. Morey Copyright © 2014 Matthew J. Peterson et al. All rights reserved. Effect of Training Supervision on Effectiveness of Strength Training for Reducing Neck/Shoulder Pain and Headache in Office Workers: Cluster Randomized Controlled Trial Wed, 19 Feb 2014 07:06:31 +0000 Objective. To investigate the effect of workplace neck/shoulder strength training with and without regular supervision on neck/shoulder pain and headache among office workers. Method. A 20-week cluster randomized controlled trial among 351 office workers was randomized into three groups: two training groups with the same total amount of planned exercises three times per week (1) with supervision (3WS) throughout the intervention period, (2) with minimal supervision (3MS) only initially, and (3) a reference group (REF). Main outcome is self-reported pain intensity in neck and shoulder (scale 0–9) and headache (scale 0–10). Results. Intention-to-treat analyses showed a significant decrease in neck pain intensity the last 7 days in 3MS compared with REF: −0.5 ± 0.2 and a tendency for 3WS versus REF: −0.4 ± 0.2 (). Intensity of headache the last month decreased in both training groups: 3WS versus REF: −1.1 ± 0.2 () and 3MS versus REF: −1.1 ± 0.2 (). Additionally, days of headache decreased 1.0 ± 0.5 in 3WS and 1.3 ± 0.5 in 3MS versus REF. There were no differences between the two training groups for any of the variables. Conclusion. Neck/shoulder training at the workplace reduced neck pain and headache among office workers independently of the extent of supervision. This finding has important practical implications for future workplace interventions. Bibi Gram, Christoffer Andersen, Mette K. Zebis, Thomas Bredahl, Mogens T. Pedersen, Ole S. Mortensen, Rigmor H. Jensen, Lars L. Andersen, and Gisela Sjøgaard Copyright © 2014 Bibi Gram et al. All rights reserved. The Application of Negative Pressure Wound Therapy in the Treatment of Chronic Venous Leg Ulceration: Authors Experience Tue, 18 Feb 2014 15:50:30 +0000 The aim of the study was to use negative pressure wound therapy (NPWT) in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6 cm2. In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg. Marek Kucharzewski, Paweł Mieszczański, Katarzyna Wilemska-Kucharzewska, Jakub Taradaj, Andrzej Kuropatnicki, and Zbigniew Śliwiński Copyright © 2014 Marek Kucharzewski et al. All rights reserved. Medium-/Long-Term Effects of a Specific Exercise Protocol Combined with Patient Education on Spine Mobility, Chronic Fatigue, Pain, Aerobic Fitness and Level of Disability in Fibromyalgia Wed, 29 Jan 2014 07:36:06 +0000 Objective. To propose a rehabilitation protocol able to produce immediate and long-term beneficial effects on level of disability and overall performance in ADLs. Materials and Methods. Forty-one FM patients were randomized to an exercise and educational-behavioral programme group (experimental group, EG = 21) or to a control group (CG = 20). Each subject was evaluated before, at the end (T1), and after 6 months (T6) from the conclusion of the rehabilitation treatment using the Fibromyalgia Impact Questionnaire (FIQ), the visual analogue scale (VAS), the Health Assessment Questionnaire (HAQ), the fatigue severity scale (FSS), the 6-minute walking test (6MWT), tender points count (TPC), and spinal active range of motion. The exercise protocol included 20 sessions consisting in self-awareness, stretching, strengthening, spine flexibility, and aerobic exercises, which patients were subsequently educated to perform at home. Results. The two groups were comparable at baseline. At T1, the EG showed a positive trend in FIQ, VAS, HAQ, and FSS scales and significant improvement in 6MWT and in most spinal active range of motion measurements (P between 0.001 and 0.04). The positive results were maintained at the follow-up. Conclusion. The proposed programme was well tolerated and produced immediate and medium-term beneficial effects improving function and strain endurance. This trial is registered with DRKS00005071 on DRKS. Erika Giannotti, Konstantinos Koutsikos, Maurizia Pigatto, Maria Elisa Rampudda, Andrea Doria, and Stefano Masiero Copyright © 2014 Erika Giannotti et al. All rights reserved. High Intensity Physical Exercise and Pain in the Neck and Upper Limb among Slaughterhouse Workers: Cross-Sectional Study Thu, 09 Jan 2014 10:03:51 +0000 Slaughterhouse work involves a high degree of repetitive and forceful upper limb movements and thus implies an elevated risk of work-related musculoskeletal disorders. High intensity strength training effectively rehabilitates musculoskeletal disorders among sedentary employees, but less is known about the effect among workers with repetitive and forceful work demands. Before performing randomized controlled trials it may be beneficial to assess the cross-sectional connection between exercise and musculoskeletal pain. We investigated the association between high intensity physical exercise and pain among 595 slaughterhouse workers in Denmark, Europe. Using logistic regression analyses, odds ratios for pain and work disability as a function of physical exercise, gender, age, BMI, smoking, and job position were estimated. The prevalence of pain in the neck, shoulder, elbow, and hand/wrist was 48%, 60%, 40%, and 52%, respectively. The odds for experiencing neck pain were significantly lower among slaughterhouse workers performing physical exercise (OR = 0.70, CI: 0.49–0.997), whereas the odds for pain in the shoulders, elbow, or hand/wrist were not associated with exercise. The present study can be used as general reference of pain in the neck and upper extremity among slaughterhouse workers. Future studies should investigate the effect of high intensity physical exercise on neck and upper limb pain in slaughterhouse workers. Emil Sundstrup, Markus D. Jakobsen, Kenneth Jay, Mikkel Brandt, and Lars L. Andersen Copyright © 2014 Emil Sundstrup et al. All rights reserved. Walking Recovery after a Hip Fracture: A Prospective Follow-Up Study among Community-Dwelling over 60-Year Old Men and Women Mon, 06 Jan 2014 12:27:40 +0000 Purpose. Recovery of walking outdoors after hip fracture is important for equal participation in the community. The causes of poor recovery are not fully understood. This study investigates recovery of walking outdoors and associated determinants after hip fracture. Methods. A prospective follow-up study, among clinical sample of 81 community-dwelling hip fracture patients over 60 years. Perceived difficulty in walking outdoors and 500 meters was assessed before fracture, at discharge to home (3.2 ± 2.2 weeks after surgery), and on average 6.0 ± 3.3 weeks after discharge. Potential determinants for walking recovery were assessed. Linear latent trajectory model was used to analyse changes during follow-up. Association between walking trajectories and potential determinants was analysed with a logistic regression model. Results. Two trajectories, No-to-minor-difficulty and Catastrophic, were found. Thirty-eight percent of the participants ended up in the Catastrophic trajectory for walking outdoors and 67% for 500 meters. Multivariate logistic regression analysis revealed that use of walking aid and indoor falls before fracture and prolonged pain were independently associated with catastrophic decline in both primary outcomes: difficulty in walking outdoors and 500 meters. Conclusions. A large proportion of community-dwelling older people recovering from hip fracture experienced catastrophic decline in outdoor walking. Acknowledging recovery prognoses at early stage enables individualized rehabilitation. Anu Salpakoski, Timo Törmäkangas, Johanna Edgren, Sanna Sihvonen, Mika Pekkonen, Ari Heinonen, Maija Pesola, Mauri Kallinen, Taina Rantanen, and Sarianna Sipilä Copyright © 2014 Anu Salpakoski et al. All rights reserved. Effect of Brief Daily Resistance Training on Occupational Neck/Shoulder Muscle Activity in Office Workers with Chronic Pain: Randomized Controlled Trial Tue, 31 Dec 2013 17:56:52 +0000 Purpose. This study investigates the acute and longitudinal effects of resistance training on occupational muscle activity in office workers with chronic pain. Methods. 30 female office workers with chronic neck and shoulder pain participated for 10 weeks in high-intensity elastic resistance training for 2 minutes per day () or in control receiving weekly email-based information on general health (). Electromyography (EMG) from the splenius and upper trapezius was recorded during a normal workday. Results. Adherence to training and control interventions were 86% and 89%, respectively. Compared with control, training increased isometric muscle strength 6% () and decreased neck/shoulder pain intensity by 40% (). The frequency of periods with complete motor unit relaxation (EMG gaps) decreased acutely in the hours after training. By contrast, at 10-week follow-up, training increased average duration of EMG gaps by 71%, EMG gap frequency by 296% and percentage time below 0.5%, and 1.0% EMGmax by 578% and 242%, respectively, during the workday in m. splenius. Conclusion. While resistance training acutely generates a more tense muscle activity pattern, the longitudinal changes are beneficial in terms of longer and more frequent periods of complete muscular relaxation and reduced pain. Mark Lidegaard, Rene B. Jensen, Christoffer H. Andersen, Mette K. Zebis, Juan C. Colado, Yuling Wang, Thomas Heilskov-Hansen, and Lars L. Andersen Copyright © 2013 Mark Lidegaard et al. All rights reserved. The Evaluation of Bioelectrical Activity of Pelvic Floor Muscles Depending on Probe Location: A Pilot Study Wed, 11 Dec 2013 08:53:16 +0000 Objectives. The main objective was to determine how the depth of probe placement affects functional and resting bioelectrical activity of the PFM and whether the recorded signal might be dependent on the direction in which the probe is rotated. Participants. The study comprised of healthy, nulliparous women between the ages of 21 and 25. Outcome Measures. Bioelectric activity of the PFM was recorded from four locations of the vagina by surface EMG and vaginal probe. Results. There were no statistically significant differences between the results during functional sEMG activity. During resting sEMG activity, the highest bioelectrical activity of the PFM was observed in the L1 and the lowest in the L4 and a statistically significant difference between the highest and the lowest results of resting sEMG activity was observed (). Conclusion. Different electrodes placement during functional contraction of PFM does not affect the obtained results in sEMG evaluation. In order to diagnose the highest resting activity of PFM the recording plates should be placed toward the anterior vaginal wall and distally from the introitus. However, all of the PFM have similar bioelectrical activity and it seems that these muscles could be treated as a single muscle. Tomasz Halski, Kuba Ptaszkowski, Lucyna Słupska, and Robert Dymarek Copyright © 2013 Tomasz Halski et al. All rights reserved. The Effect of NeuroMuscular Electrical Stimulation on Quadriceps Strength and Knee Function in Professional Soccer Players: Return to Sport after ACL Reconstruction Thu, 05 Dec 2013 09:22:05 +0000 The aim of this study was to assess the clinical efficacy and safety of NMES program applied in male soccer players (after ACL reconstruction) on the quadriceps muscle. The 80 participants (NMES = 40, control = 40) received an exercise program, including three sessions weekly. The individuals in NMES group additionally received neuromuscular electrical stimulation procedures on both right and left quadriceps (biphasic symmetric rectangular pulses, frequency of impulses: 2500 Hz, and train of pulses frequency: 50 Hz) three times daily (3 hours of break between treatments), 3 days a week, for one month. The tensometry, muscle circumference, and goniometry pendulum test (follow-up after 1 and 3 months) were applied. The results of this study show that NMES (in presented parameters in experiment) is useful for strengthening the quadriceps muscle in soccer athletes. There is an evidence of the benefit of the NMES in restoring quadriceps muscle mass and strength of soccer players. In our study the neuromuscular electrical stimulation appeared to be safe for biomechanics of knee joint. The pathological changes in knee function were not observed. This trial is registered with Australian and New Zealand Clinical Trials Registry ACTRN12613001168741. J. Taradaj, T. Halski, M. Kucharzewski, K. Walewicz, A. Smykla, M. Ozon, L. Slupska, R. Dymarek, K. Ptaszkowski, J. Rajfur, and M. Pasternok Copyright © 2013 J. Taradaj et al. All rights reserved. Effect of Kinesiology Taping on Breast Cancer-Related Lymphedema: A Randomized Single-Blind Controlled Pilot Study Wed, 27 Nov 2013 09:34:54 +0000 The aim of the study was to assess the efficacy of Kinesiology Taping (KT) for treating breast cancer-related lymphedema. Sixty-five women with unilateral stage II and III lymphedema were randomly grouped into the KT group (K-tapes, ), the Quasi KT group (quasi K-tapes, ), or the MCT group (multilayered compression therapy group, ). Skin care, 45 min pneumatic compression therapy, 1 h manual lymphatic drainage, and application of K-tape/Quasi K-tapes/multilayered short-stretch bandages were given every treatment session, 3 times per week for 1 month. Patient evaluation items included limb size and percentage edema. Comparing the changes in K-tapes with quasi K-tapes changes, there were no significant differences (). The edema reduction of multilayered bandages was much better than in results observed in taping groups. The KT appeared to be ineffective at secondary lymphedema after breast cancer treatment. The single-blind, controlled pilot study results suggest that K-tape could not replace the bandage, and at this moment it must not be an alternative choice for the breast cancer-related lymphedema patient. The trial is registered with ACTRN12613001173785. A. Smykla, K. Walewicz, R. Trybulski, T. Halski, M. Kucharzewski, C. Kucio, W. Mikusek, K. Klakla, and J. Taradaj Copyright © 2013 A. Smykla et al. All rights reserved. Robotic Technologies and Rehabilitation: New Tools for Stroke Patients’ Therapy Wed, 20 Nov 2013 17:07:29 +0000 Introduction. The role of robotics in poststroke patients’ rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients’ rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient’s characteristics to be successfully enrolled to this treatment. Patrizia Poli, Giovanni Morone, Giulio Rosati, and Stefano Masiero Copyright © 2013 Patrizia Poli et al. All rights reserved. Measuring Activity Levels at an Acute Stroke Ward: Comparing Observations to a Device Sun, 27 Oct 2013 08:09:43 +0000 Background. If a simple system of instrumented monitoring was possible early after stroke, therapists may be able to more readily gather information about activity and monitor progress over time. Our aim was to establish whether a device containing a dual-axis accelerometer provides similar information to behavioural mapping on physical activity patterns early after stroke. Methods. Twenty participants with recent stroke ≤2 weeks and aged >18 were recruited and monitored at an acute stroke ward. The monitoring device (attached to the unaffected leg) and behavioural mapping (observation) were simultaneously applied from 8 a.m. to 5 p.m. Both methods recorded the time participants spent lying, sitting, and upright. Results. The median percentage and interquartile range (IQR) of time spent lying, sitting, and upright recorded by the device were 36% (15–68), 51% (28–72), and 2% (1–5), respectively. Agreement between the methods was substantial: Intraclass Correlation Coefficient (95% CI): lying 0.74 (0.46–0.89), sitting 0.68 (0.36–0.86), and upright 0.72 (0.43–0.88). Conclusion. Patients are inactive in an acute stroke setting. In acute stroke, estimates of time spent lying, sitting, and upright measured by a device are valid. Sharon F. Kramer, Toby Cumming, Leonid Churilov, and Julie Bernhardt Copyright © 2013 Sharon F. Kramer et al. All rights reserved. The Value of Pain Coping Constructs in Subcategorising Back Pain Patients according to Risk of Poor Outcome Thu, 24 Oct 2013 13:50:05 +0000 Background. Subcategorising patients with chronic low back pain (CLBP) could improve patient outcomes and facilitate prioritisation of treatment resources. Objective. This study aimed to develop a subcategorising method for individuals with CLBP using the Coping Strategies Questionnaire 24 (CSQ24) and to investigate the methods potential validity. Methods. 196 patients were recruited from a physiotherapy outpatients department. All participants completed a battery of questionnaires before and after treatment including the CSQ24 and a measure of pain, disability, and mood. At discharge participants also completed a global subjective outcomes scale consisting of a 6-point Likert scale. All participants received usual physiotherapy. Results. Cut-off values for the CSQ24 were calculated using triangulation of the findings from three different statistical methods. Cut-off values were identified for the Catastrophising and Cognitive Coping subscales of the CSQ24. Participants were categorised into low, medium, and high risk of a poor outcome. The cut-off values for these were ≥21 on Cognitive Coping and ≤9 on Catastrophising for low risk and ≤15 on Cognitive Coping for high risk, with all other patients being classified as being at moderate risk. Conclusion. Further validation is required before this approach can be recommended for clinical practice. Nicholas Harland and Cormac Gerard Ryan Copyright © 2013 Nicholas Harland and Cormac Gerard Ryan. All rights reserved. Body Posture Asymmetry Differences between Children with Mild Scoliosis and Children with Unilateral Cerebral Palsy Wed, 09 Oct 2013 14:05:52 +0000 Patients with unilateral cerebral palsy (CP) often have impaired movement coordination, reduced between-limb synchronization, and less weight bearing on the affected side, which can affect the maintenance of an upright weight-bearing position and gait. This study evaluated whether the different postural patterns of children with unilateral CP could be statistically recognized using cluster analysis. Forty-five outpatients with unilateral CP (mean age, 9 years and 5 months) and 51 able-bodied children with mild scoliosis (mean age, 9 years and 2 months) were included. One observer performed moiré topography (MT) examinations using a CQ Electronic System (Poland) device. A weight distribution analysis on the base of support (BOS) between the body sides was performed simultaneously. A force plate dynamographic platform (PDM), ZEBRIS (Germany), with FootPrint software was used for these measurements. Cluster analysis revealed three groups: Cluster 1 (, 73.96%), Cluster 2 (, 8.33%), and Cluster 3 (, 17.71%). Based on the MT parameters (extracted using a data reduction technique), three typical asymmetrical postural patterns were described: (1) the postural pattern of children with mild scoliosis (SCOL), (2) the progravitational postural pattern (PGPP), and (3) the antigravitational pattern. Patterns two and three were identified in children with unilateral CP. Małgorzata Domagalska-Szopa and Andrzej Szopa Copyright © 2013 Małgorzata Domagalska-Szopa and Andrzej Szopa. All rights reserved. Differences in Muscle Activation Patterns during Sit to Stand Task among Subjects with and without Intellectual Disability Mon, 07 Oct 2013 14:48:18 +0000 The aim of this study is to analyse the differences in muscle activity between subjects who have intellectual disability and healthy subjects when they make the transition from sitting to standing positions. A cross-sectional study. A group of adults was divided into two subgroups: with and without intellectual disability (ID). The means of the basic features in both groups were 22.13 and 22.83 for age, 66.38 and 67.67 for weight, and 173.38 and 174.33 for height, for the ID () and without ID () groups, respectively. Each subject performed three sets of five repetitions during which, starting from sitting, they had to get up and sit on the chair. The recording of muscle activity was performed using surface electromyography taking the measures of muscle activity of different muscles of the lower limbs. The results showed differences in the pattern of muscle activity between groups during sitting to standing movement. Antonio I. Cuesta-Vargas and Manuel González-Sánchez Copyright © 2013 Antonio I. Cuesta-Vargas and Manuel González-Sánchez. All rights reserved. Modeling the Prospective Relationships of Impairment, Injury Severity, and Participation to Quality of Life Following Traumatic Brain Injury Wed, 02 Oct 2013 14:59:06 +0000 Identifying reliable predictors of positive adjustment following traumatic brain injury (TBI) remains an important area of inquiry. Unfortunately, much of available research examines direct relationships between predictor variables and outcomes without attending to the contextual relationships that can exist between predictor variables. Relying on theoretical models of well-being, we examined a theoretical model of adjustment in which the capacity to engage in intentional activities would be prospectively associated with greater participation, which in turn would predict subsequent life satisfaction and perceived health assessed at a later time. Structural equation modeling of data collected from 312 individuals (226 men, 86 women) with TBI revealed that two elements of participation—mobility and occupational activities—mediated the prospective influence of functional independence and injury severity to optimal adjustment 60 months following medical discharge for TBI. The model accounted for 21% of the variance in life satisfaction and 23% of the variance in self-rated health. Results indicate that the effects of functional independence and injury severity to optimal adjustment over time may be best understood in the context of participation in meaningful, productive activities. Implications for theoretical models of well-being and for clinical interventions that promote adjustmentafter TBI are discussed. Ryan J. Kalpinski, Meredith L. C. Williamson, Timothy R. Elliott, Jack W. Berry, Andrea T. Underhill, and Philip R. Fine Copyright © 2013 Ryan J. Kalpinski et al. All rights reserved. Rehabilitation of Children with Hemiparesis: A Pilot Study on the Use of Virtual Reality Wed, 02 Oct 2013 09:00:10 +0000 Background. A wide range of treatments have been used to improve upper arm motor performances in children with congenital hemiplegia. Recent findings are suggesting that virtual reality based intervention could be a promising tool also in pediatric rehabilitation. Methods. Six patients with congenital hemiplegia (age: 4–16 years) were recruited among those treated in the Child Neuropsychiatry and Rehabilitation Unit of the IRCCS “Santa Maria Nascente” (Milan, Italy), for a preliminary investigation about using nonimmersive virtual reality for upper limb rehabilitation. Ten sessions using VRRS system (Khymeia, Padova, Italy) were weekly administered as a part of the rehabilitative treatment. Melbourne Assessment of Unilateral Limb Movement, Ashworth Scale, and Arm’s PROM were selected as main outcome measures. At the end of treatment, participants filled in an ad hoc satisfaction questionnaire. Results. All subjects completed the proposed treatment, and they also gave a positive judgment regarding this rehabilitative method. Melbourne score increased in all patients. Conclusion. Our findings seem to support the evidence that VR treatment could be a promising and engaging tool for pediatric rehabilitation. However, the limited size of the population and the small number of sessions require further investigations and RCTs to confirm our positive results. Ivana Olivieri, Matteo Chiappedi, Paolo Meriggi, Marcella Mazzola, Attilia Grandi, and Lucia Angelini Copyright © 2013 Ivana Olivieri et al. All rights reserved. Exercise Trajectories of Women from Entry to a 6-Month Cardiac Rehabilitation Program to One Year after Discharge Thu, 12 Sep 2013 12:16:16 +0000 Background. Physical activity is associated with reduced mortality and morbidity. Cardiac rehabilitation (CR) is an effective intervention for patients with cardiovascular disease (CVD). Unfortunately, women are less likely to engage in, or sustain, regular physical activity. Objectives were to (1) describe women’s guidelines-based levels of physical activity during and after CR and (2) determine the physical activity trajectories of women from entry to CR to one year after CR. Methods and Results. A prospective, longitudinal study of 203 women with CVD enrolled in a 6-month CR program. Physical activity was measured using the Godin Leisure Time Exercise Questionnaire (LSI), focusing on moderate-strenuous activity. Data were analyzed using latent class growth analysis (LCGA) and logistic regression. Mean scores on the LSI showed women to be “active” at all follow-up points. LCGA revealed a two-class model, respectively, called “inactive relapsers” and “moderately active relapsers.” Predictors of the “moderately active relapsers” class were employment status and diagnosis of myocardial infarction. Conclusions. Women achieved the recommended physical activity levels by the end of CR and sustained them until one year after CR. LCGA allowed us to determine the class trajectories associated with moderate-strenuous activity and, from these, to identify implications for targeted intervention. Heather M. Arthur, Chris Blanchard, Elizabeth Gunn, Jennifer Kodis, Steven Walker, and Brenda Toner Copyright © 2013 Heather M. Arthur et al. All rights reserved. Association of Seat Height and Arm Position on the Five Times Sit-to-Stand Test Times of Stroke Survivors Wed, 11 Sep 2013 09:20:07 +0000 Objectives. To investigate (1) the association of seat height and (2) the association of arm position on the five times sit-to-stand test (FTSTS) times of individuals with stroke. Design. A cross-sectional study. Setting. University-based rehabilitation centre. Subjects. Patients () with chronic stroke. Methods. The times in completing the FTSTS with different seat height (85%, 100%, and 115% knee height) and arm positions (arms across chest, hands on thighs). Results. FTSTS times were significantly different between 85% and 100% seat heights, and between the 85% and 115% seat heights in both arm positions. However, there was no significant difference between the FTSTS times with the two arm positions at any seat height tested. Conclusion. Seat heights lower than the knee height result in longer FTSTS times, whereas arms positions did not significantly affect the FTSTS times. Shamay S. M. Ng, Susanna Y. Cheung, Lauren S. W. Lai, Ann S. L. Liu, Selena H. I. Ieong, and Shirley S. M. Fong Copyright © 2013 Shamay S. M. Ng et al. All rights reserved. Chair-Based Exercises for Frail Older People: A Systematic Review Mon, 09 Sep 2013 08:45:26 +0000 Introduction. Frail older people are often unable to undertake high-intensity exercise programmes. Chair-based exercises (CBEs) are used as an alternative, for which health benefits are uncertain. Objective. To examine the effects of CBE programmes for frail older people through a systematic review of existing literature. Method. A systematic search was performed for CBE-controlled trials in frail populations aged ≥65 years published between 1990 and February 2011 in electronic databases. Quality was assessed using the Jadad method. Results. The search identified 164 references: with 42 duplicates removed, 122 reviewed, 116 excluded, and 6 analysed. 26 outcome measures were reported measuring 3 domains: mobility and function, cardiorespiratory fitness, mental health. All studies were of low methodological quality (Jadad score ≤2; possible range 0–5). Two studies showed no benefit, and four reported some evidence of benefit in all three domains. No harmful effects were reported; compliance was generally good. Conclusion. The quality of the evidence base for CBEs is low with inconclusive findings to clearly inform practice. A consensus is required on the definition and purpose of CBEs. Large well-designed randomised controlled trials to test the effectiveness of CBE are justified. Kevin Anthony, Katie Robinson, Philippa Logan, Adam L. Gordon, Rowan H. Harwood, and Tahir Masud Copyright © 2013 Kevin Anthony et al. All rights reserved. Neurocognitive Functioning in Schizophrenia and during the Early Phases of Psychosis: Targeting Cognitive Remediation Interventions Thu, 05 Sep 2013 14:31:46 +0000 Recent interest in the early course of schizophrenia accentuated altered cognition prior to the onset. Ultrahigh risk (UHR) individuals with attenuated positive symptoms and transient psychotic episodes demonstrate neurocognitive deficits across multiple domains such as memory, executive functioning, and processing speed which are consistent with similar disturbances identified in patients with a first episode of schizophrenia. Cognitive remediation (CR) approaches representing a broad set of activities are aimed to restore or improve cognitive functioning. CR proved to be effective in modulating the cognitive dysfunction in schizophrenia but is rarely used in ultrahigh risk individuals. From the clinical prospective, a better understanding of cognitive functioning in at-risk states is essential for the development of optimal early intervention models. In the review, we highlight the intervention targets, notably the specific cognitive deficits in at risk individuals which preceed the transition to psychosis and emphasize the need of the additional studies using CR approaches in UHR group aiming to enhance cognition and therefore mediate functional improvement. Yulia Zaytseva, Natalya Korsakova, Mark Agius, and Isaac Gurovich Copyright © 2013 Yulia Zaytseva et al. All rights reserved. The Usefulness of Impedance Cardiography for Predicting Beneficial Effects of Cardiac Rehabilitation in Patients with Heart Failure Mon, 26 Aug 2013 17:30:35 +0000 Aim. Cardiac rehabilitation (CR) is an important part of heart failure (HF) treatment. The aim of this paper was to evaluate if thoracic fluid content (TFC) measured by impedance cardiography (ICG) is a useful parameter for predicting the outcome of CR. Methods. Fifty HF patients underwent clinical and noninvasive haemodynamic (TFC) assessments before and after 8-week CR. Results. As a result of CR, the patients’ exercise tolerance improved, especially in terms of peak VO2 (18.7 versus 20.8 mL × kg−1 × min−1; ). TFC was found to identify patients with significantly improved peak VO2 after CR. “High TFC” patients (TFC > 27.0 kOhm−1), compared to those of “low TFC” (TFC < 27.0 kOhm−1), were found to have more pronounced increase in peak VO2 (1.3 versus 3.1 mL × kg−1 × min−1; ) and decrease in TFC (4.0 versus 0.7 kOhm−1; ). On the other hand, the patients with improved peak VO2 () differed from those with no peak VO2 improvement in terms of higher baseline TFC values (28.4 versus 25.3 kOhm−1; ) and its significant decrease after CR (2.7 versus 0.2 kOhm−1; ). Conclusions. TFC can be a useful parameter for predicting beneficial effects of CR worth including in the process of patients’ qualification for CR. Grzegorz Gielerak, Paweł Krzesiński, Ewa Piotrowicz, and Ryszard Piotrowicz Copyright © 2013 Grzegorz Gielerak et al. All rights reserved. Rehabilitation after ACL Injury: A Fluoroscopic Study on the Effects of Type of Exercise on the Knee Sagittal Plane Arthrokinematics Mon, 26 Aug 2013 15:07:25 +0000 A safe rehabilitation exercise for anterior cruciate ligament (ACL) injuries needs to be compatible with the normal knee arthrokinematics to avoid abnormal loading on the joint structures. The objective of this study was to measure the amount of the anterior tibial translation (ATT) of the ACL-deficient knees during selective open and closed kinetic chain exercises. The intact and injured knees of fourteen male subjects with unilateral ACL injury were imaged using uniplanar fluoroscopy, while the subjects performed forward lunge and unloaded/loaded open kinetic knee extension exercises. The ATTs were measured from fluoroscopic images, as the distance between the tibial and femoral reference points, at seven knee flexion angles, from 0° to 90°. No significant differences were found between the ATTs of the ACL-deficient and intact knees at all flexion angles during forward lunge and unloaded open kinetic knee extension (). During loaded open kinetic knee extension, however, the ATTs of the ACL deficient knees were significantly larger than those of the intact knees at 0° (). It was suggested that the forward lunge, as a weight-bearing closed kinetic chain exercise, provides a safer approach for developing muscle strength and functional stability in rehabilitation program of ACL-deficient knees, in comparison with open kinetic knee extension exercise. Sadegh Norouzi, Fateme Esfandiarpour, Ali Shakourirad, Reza Salehi, Mohammad Akbar, and Farzam Farahmand Copyright © 2013 Sadegh Norouzi et al. All rights reserved. Physical Activity Patterns of Acute Stroke Patients Managed in a Rehabilitation Focused Stroke Unit Mon, 19 Aug 2013 10:07:20 +0000 Background. Comprehensive stroke unit care, incorporating acute care and rehabilitation, may promote early physical activity after stroke. However, previous information regarding physical activity specific to the acute phase of stroke and the comprehensive stroke unit setting is limited to one stroke unit. This study describes the physical activity undertaken by patients within 14 days after stroke admitted to a comprehensive stroke unit. Methods. This study was a prospective observational study. Behavioural mapping was used to determine the proportion of the day spent in different activities. Therapist reports were used to determine the amount of formal therapy received on the day of observation. The timing of commencement of activity out of bed was obtained from the medical records. Results. On average, patients spent 45% (SD 25) of the day in some form of physical activity and received 58 (SD 34) minutes per day of physiotherapy and occupational therapy combined. Mean time to first mobilisation out of bed was 46 (SD 32) hours post-stroke. Conclusions. This study suggests that commencement of physical activity occurs earlier and physical activity is at a higher level early after stroke in this comprehensive stroke unit, when compared to studies of other acute stroke models of care. Tanya West and Julie Bernhardt Copyright © 2013 Tanya West and Julie Bernhardt. All rights reserved. High-Frequency Transcutaneous Peripheral Nerve Stimulation Induces a Higher Increase of Heat Pain Threshold in the Cutaneous Area of the Stimulated Nerve When Confronted to the Neighbouring Areas Tue, 06 Aug 2013 11:20:36 +0000 Background. TENS (transcutaneous electrical nerve stimulation) is probably the most diffused physical therapy used for antalgic purposes. Although it continues to be used by trial and error, correct targeting of paresthesias evoked by the electrical stimulation on the painful area is diffusely considered very important for pain relief. Aim. To investigate if TENS antalgic effect is higher in the cutaneous area of the stimulated nerve when confronted to neighbouring areas. Methods. 10 volunteers (4 males, 6 females) underwent three different sessions: in two, heat pain thresholds (HPTs) were measured on the dorsal hand skin before, during and after electrical stimulation (100 Hz, 0.1 msec) of superficial radial nerve; in the third session HPTs, were measured without any stimulation. Results. Radial nerve stimulation induced an increase of HPT significantly higher in its cutaneous territory when confronted to the neighbouring ulnar nerve territory, and antalgic effect persisted beyond the stimulation time. Conclusions. The location of TENS electrodes is crucial for obtaining the strongest pain relief, and peripheral nerve trunk stimulation is advised whenever possible. Moreover, the present study indicates that continuous stimulation could be unnecessary, suggesting a strategy for avoiding the well-known tolerance-like effect of prolonged TENS application. M. Buonocore, N. Camuzzini, M. Cecini, and E. Dalla Toffola Copyright © 2013 M. Buonocore et al. All rights reserved. Effects of a Rehabilitation Program on Perceived Environmental Barriers in Older Patients Recovering from Hip Fracture: A Randomized Controlled Trial Tue, 06 Aug 2013 09:06:24 +0000 Objectives. To study effects of a one-year multicomponent intervention on perceived environmental barriers in hip fracture patients. Design. Randomized controlled trial of a 12-month home-based rehabilitation aiming to improve mobility and function (ISRCTN53680197); secondary analyses. Subjects. Community-dwelling hip fracture patients on average 70 days after trauma (). Methods. Assessments at baseline, 3, 6, and 12 months later included perceived entrance-related barriers (e.g., indoor/outdoor stairs, lighting, floor surfaces, and storage for mobility devices) and perceived barriers in the outdoor environment (poor street condition, hilly terrain, long-distances, and lack of resting places). Sum scores for entrance-related and outdoor barriers were analyzed using general estimating equation models. Results. At baseline, 48% and 37% of the patients perceived at least one entrance-related barrier, and 62% and 60% perceived at least one outdoor barrier in the intervention and control group, respectively. Over time, () the number of entrance-related barriers decreased in both groups (group ; interaction ). For outdoor barriers, time (), group (), and interaction effect () were not significant. Conclusion. Our intervention had no additional benefit over standard care in hip fracture patients. Further study is warranted to determine whether perceived environmental barriers can be reduced by interventions targeted at the older individual. This trial is registered with ISRCTN53680197. Erja Portegijs, Merja Rantakokko, Johanna Edgren, Anu Salpakoski, Ari Heinonen, Marja Arkela, Mauri Kallinen, Taina Rantanen, and Sarianna Sipilä Copyright © 2013 Erja Portegijs et al. All rights reserved. Variables Associated with Performance of an Active Limb Movement following Within-Session Instruction in People with and People without Low Back Pain Thu, 01 Aug 2013 10:56:45 +0000 Modification of a movement pattern can be beneficial in decreasing low back pain (LBP) symptoms. There is variability, however, in how well people are able to modify performance of a movement. What has not been identified is the factors that may affect a person’s ability to modify performance of a movement. We examined factors related to performance of active hip lateral rotation (HLR) following standardized instructions in people with and people without LBP. Data were collected during performance of HLR under 3 conditions: passive, active, and active instructed. In people with LBP, motion demonstrated during the passive condition (, ), motion demonstrated during the active condition (, ), and gender (, ) were related to motion demonstrated during the active-instructed condition. Motion demonstrated during the passive condition explained 76% of the variance in motion demonstrated during the active-instructed condition. A similar relationship did not exist in people without LBP. The findings of the study suggest that it may be important to assess motion demonstrated during passive HLR to determine how difficult it will be for someone with LBP to modify the performance of HLR. Prognosis should be worst for those who display similar movement patterns during passive HLR and active-instructed HLR. Sara A. Scholtes, Barbara J. Norton, Sara P. Gombatto, and Linda R. Van Dillen Copyright © 2013 Sara A. Scholtes et al. All rights reserved. Respiratory Muscle Training in Patients Recovering Recent Open Cardiothoracic Surgery: A Randomized-Controlled Trial Tue, 30 Jul 2013 12:27:49 +0000 Objectives. To evaluate the clinical efficacy and feasibility of an expiratory muscle training (EMT) device (Respilift) applied to patients recovering from recent open cardiothoracic surgery (CTS). Design. Prospective, double-blind, 14-day randomised-controlled trial. Participants and Setting. A total of 60 inpatients recovering from recent CTS and early admitted to a pulmonary rehabilitation program. Interventions. Chest physiotherapy plus EMT with a resistive load of 30 cm H2O for active group and chest physiotherapy plus EMT with a sham load for control group. Measures. Changes in maximal expiratory pressure (MEP) were considered as primary outcome, while maximal inspiratory pressures (MIP), dynamic and static lung volumes, oxygenation, perceived symptoms of dyspnoea, thoracic pain, and well being (evaluated by visual analogic scale—VAS) and general health status were considered secondary outcomes. Results. All outcomes recorded showed significant improvements in both groups; however, the change of MEP (+34.2 mmHg, and +26.1%, for absolute and % of predicted, resp.) was significantly higher in active group. Also VAS dyspnoea improved faster and more significantly () at day 12, and 14 in active group when compared with control. The drop-out rate was 6%, without differences between groups. Conclusions. In patients recovering from recent CTS, specific EMT by Respilift is feasible and effective. This trial is registered with NCT01510275. Ernesto Crisafulli, Elena Venturelli, Gherardo Siscaro, Fabio Florini, Alessandra Papetti, Daniela Lugli, Massimo Cerulli, and Enrico Clini Copyright © 2013 Ernesto Crisafulli et al. All rights reserved. Sustainability of Tailored Goal Oriented Community Brief Intervention Model among Risky Drinkers in Community in Thailand Wed, 17 Jul 2013 09:30:19 +0000 Tailored Goal Oriented Community Brief Intervention Model (TGCBI), first implemented as culturally secure and acceptable to communities in Thailand, is designed in 2 stages or levels: community level, a culturally secure approach to motivate participants to reconsider their drinking behavior; individual level, involved in the key messages received from the community level together with additional input focused towards individuals. TGCBI’s effectiveness was measured by the number of abstinent drinkers and number of alcohol-free months among those who continued to drink at followup in two communities that originally had high prevalence of risky drinking. Multivariate Poisson regression was used to investigate the intervention effect. Results indicated that the number of participants who stopped drinking 6 months later and the number of alcohol-free months during followup were significantly greater () for 47 participants in the intervention group compared to the control group (). TGCBI results in sustainable drinking cessation. Chitlada Areesantichai, Usaneya Perngparn, and Catherine Pilley Copyright © 2013 Chitlada Areesantichai et al. All rights reserved. Addressing the Question of Disorder-Specific Risk Factors of Internet Addiction: A Comparison of Personality Traits in Patients with Addictive Behaviors and Comorbid Internet Addiction Tue, 25 Jun 2013 14:53:37 +0000 Uncontrolled use of the internet has been reported to affect the lives of some users in a negative way. According to epidemiological studies, about 1% of the general population is showing signs of internet addiction. Since internet addiction is becoming a growing health concern, research on potential risk factors is becoming more important in order to develop strategies for prevention and to adopt therapeutic treatment. Although there are some studies investigating personality traits in internet addiction, most of these studies are based on samples of healthy subjects. In this research project, we compared personality profiles of a sample of patients in different rehabilitation centers. 70 patients with an addiction disorder that additionally met the criteria for internet addiction were compared to 48 patients suffering from alcohol dependence. Besides Big Five personality traits, we also assessed depressive symptoms. It was shown that patients with comorbid internet addiction can be discriminated from other patients by higher neuroticism and lower extraversion as well as lower conscientiousness. After controlling for depressive symptoms, lower conscientiousness especially turned out to be a disorder-specific risk factor. As internet addiction is related to unique patterns of personality traits and can be discriminated from alcohol dependence, treatment approaches are needed that meet the specific requirements of patients with internet addiction. K. W. Müller, A. Koch, U. Dickenhorst, M. E. Beutel, E. Duven, and K. Wölfling Copyright © 2013 K. W. Müller et al. All rights reserved. Comparison of Breast Cancer-Related Lymphedema (Upper Limb Swelling) Prevalence Estimated Using Objective and Subjective Criteria and Relationship with Quality of Life Tue, 18 Jun 2013 14:17:30 +0000 This study aimed to investigate lymphedema prevalence using three different measurement/diagnostic criterion combinations and explore the relationship between lymphedema and quality of life for each, to provide evaluation of rehabilitation. Cross-sectional data from 617 women attending review appointments after completing surgery, chemotherapy, and radiotherapy included the Morbidity Screening Tool (MST; criterion: yes to lymphedema); Lymphedema and Breast Cancer Questionnaire (LBCQ; criterion: yes to heaviness and/or swelling); percentage limb volume difference (perometer: %LVD; criterion: 10%+ difference); and the Functional Assessment of Cancer Therapy breast cancer-specific quality of life tool (FACT B+4). Perometry measurements were conducted in a clinic room. Between 341 and 577 participants provided sufficient data for each analysis, with mean age varying from 60 to 62 (SD 9.95–10.03) and median months after treatment from 49 to 51. Lymphedema prevalence varied from 26.2% for perometry %LVD to 20.5% for the MST and 23.9% for the LBCQ; differences were not significant. Limits of agreement analysis between %LVD and the subjective measures showed little consistency, while moderate consistency resulted between the subjective measures. Quality of life differed significantly for women with and without lymphedema only when subjective measurements were used. Results suggest that subjective and objective tools investigate different aspects of lymphedema. Catherine Bulley, Susanne Gaal, Fiona Coutts, Christine Blyth, Wilma Jack, Udi Chetty, Matthew Barber, and Chee-Wee Tan Copyright © 2013 Catherine Bulley et al. All rights reserved. Effect of Therapy Ball Seating on Learning and Sitting Discomforts among Saudi Female Students Mon, 10 Jun 2013 09:25:43 +0000 The aim of the study was to evaluate the effect of therapy ball seating as an alternative for typical chair seating in a classroom. We evaluated the effect of ball seating on the student's sitting discomfort and academic performance using Cornell Musculoskeletal Discomfort Questionnaire and problem-based learning scales, respectively. A sample of convenience was taken. Data was collected and analyzed using t-test. Subjects experienced a major discomfort at neck and a minor discomfort at knee joint. Results showed that there was a significant improvement () in sitting discomfort and student's performance when seated on therapy balls compared to typical classroom chairs. This study provides evidence for the effectiveness of therapy balls as a classroom seating for students who exhibit sitting discomfort and problem-based learning. Einas Al-Eisa, Syamala Buragadda, and Ganeswara Rao Melam Copyright © 2013 Einas Al-Eisa et al. All rights reserved. Intra- and Interday Reliability of Spine Rasterstereography Sun, 02 Jun 2013 18:44:22 +0000 To determine intra- and interday reliability of spine rasterstereographic system Formetric 4D with and without reflective markers. Twenty-six healthy volunteers (M group) had two markers placed in correspondence of vertebra prominens and intergluteal cleft, and 24 volunteers (NM group) were assessed without markers. All participants were analyzed two times in the same day and one time on a separate day. Trunk length, kyphotic angle, lordotic angle, pelvic inclination, kyphotic and lordotic apex, right and left lateral deviation, flèche cervicale and lombaire, trunk imbalance, pelvic tilt, inflection point, rotation correction, right and left surface rotation, pelvic torsion, and trunk torsion were measured. Intraclass correlation coefficient (ICC) and Cronbach Alpha (Cα) were calculated. In M group, for intra-, interday, and overall evaluations, the higher reliability coefficients were 0.971, 0.963, and 0.958 (ICC) and 0.987, 0.983, and 0.985 (Cα) for trunk length, kyphotic angle, and lordotic apex, respectively; while in NM group, they were 0.978, 0.982, and 0.972 and 0.989, 0.991, and 0.991 for trunk length. In M group, the lower values were 0.598, 0.515, and 0.534 (ICC) and 0.742, 0.682, and 0.784 (Cα) for trunk and pelvic torsion and in NM group 0.561, 0.537, and 0.461 and 0.731, 0.695, and 0.729 for left lateral deviation. The reliability of most parameters was excellent. Laura Guidetti, Valerio Bonavolontà, Alessandro Tito, Victor M. Reis, Maria Chiara Gallotta, and Carlo Baldari Copyright © 2013 Laura Guidetti et al. All rights reserved.