BioMed Research International: Rehabilitation The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Can Rehabilitation Influence the Efficiency of Control Signals in Complex Motion Strategies? Wed, 24 May 2017 06:43:05 +0000 The factor determining quality of life in Parkinson’s disease (PD) is the worsening of a patient’s walking ability. The use of external stimuli can improve gait when performing complex motor patterns. The aim of this study was to evaluate the effect of rehabilitation on the effectiveness of control signals in people with PD. The study was performed on 42 people with idiopathic PD in the third stage of disease. The control group consisted of 19 patients who did not participate in rehabilitation activities. The experimental group was systematically participating in rehabilitation activities twice a week (60 minutes) for 9 months. Gait speed, mean step length, and step frequency were calculated on the basis of the obtained results. These parameters were compared in both groups by single factor variance analyses. The best results were obtained using rhythmic external auditory signals. The group with patients actively participating in rehabilitation showed statistically significant improvement in gait speed (12.35%), mean step length (18.00%), and frequency step (2.40%) compared to the control group. The presented research showed the positive effect of rehabilitation and was based on the performance of complex motion patterns, using external control signals for their effectiveness in new motion tasks. Joanna Cholewa, Jaroslaw Cholewa, Agnieszka Gorzkowska, Andrzej Malecki, and Arkadiusz Stanula Copyright © 2017 Joanna Cholewa et al. All rights reserved. The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review Thu, 11 May 2017 09:50:17 +0000 The lumbodorsal fascia (LF) has been proposed to represent a possible source of idiopathic low back pain. In fact, histological studies have demonstrated the presence of nociceptive free nerve endings within the LF, which, furthermore, appear to exhibit morphological changes in patients with chronic low back pain. However, it is unclear how these characteristics relate to the aetiology of the pain. In vivo elicitation of back pain via experimental stimulation of the LF suggests that dorsal horn neurons react by increasing their excitability. Such sensitization of fascia-related dorsal horn neurons, in turn, could be related to microinjuries and/or inflammation in the LF. Despite available data point towards a significant role of the LF in low back pain, further studies are needed to better understand the involved neurophysiological dynamics. Jan Wilke, Robert Schleip, Werner Klingler, and Carla Stecco Copyright © 2017 Jan Wilke et al. All rights reserved. Neural Engineering for Rehabilitation Sun, 30 Apr 2017 06:21:36 +0000 Han-Jeong Hwang, Do-Won Kim, Janne M. Hahne, and Jongsang Son Copyright © 2017 Han-Jeong Hwang et al. All rights reserved. Improving the Robustness of Real-Time Myoelectric Pattern Recognition against Arm Position Changes in Transradial Amputees Mon, 24 Apr 2017 09:30:12 +0000 Previous studies have showed that arm position variations would significantly degrade the classification performance of myoelectric pattern-recognition-based prosthetic control, and the cascade classifier (CC) and multiposition classifier (MPC) have been proposed to minimize such degradation in offline scenarios. However, it remains unknown whether these proposed approaches could also perform well in the clinical use of a multifunctional prosthesis control. In this study, the online effect of arm position variation on motion identification was evaluated by using a motion-test environment (MTE) developed to mimic the real-time control of myoelectric prostheses. The performance of different classifier configurations in reducing the impact of arm position variation was investigated using four real-time metrics based on dataset obtained from transradial amputees. The results of this study showed that, compared to the commonly used motion classification method, the CC and MPC configurations improved the real-time performance across seven classes of movements in five different arm positions (8.7% and 12.7% increments of motion completion rate, resp.). The results also indicated that high offline classification accuracy might not ensure good real-time performance under variable arm positions, which necessitated the investigation of the real-time control performance to gain proper insight on the clinical implementation of EMG-pattern-recognition-based controllers for limb amputees. Yanjuan Geng, Oluwarotimi Williams Samuel, Yue Wei, and Guanglin Li Copyright © 2017 Yanjuan Geng et al. All rights reserved. EEG-Based Computer Aided Diagnosis of Autism Spectrum Disorder Using Wavelet, Entropy, and ANN Tue, 18 Apr 2017 09:49:46 +0000 Autism spectrum disorder (ASD) is a type of neurodevelopmental disorder with core impairments in the social relationships, communication, imagination, or flexibility of thought and restricted repertoire of activity and interest. In this work, a new computer aided diagnosis (CAD) of autism ‎based on electroencephalography (EEG) signal analysis is investigated. The proposed method is based on discrete wavelet transform (DWT), entropy (En), and artificial neural network (ANN). DWT is used to decompose EEG signals into approximation and details coefficients to obtain EEG subbands. The feature vector is constructed by computing Shannon entropy values from each EEG subband. ANN classifies the corresponding EEG signal into normal or autistic based on the extracted features. The experimental results show the effectiveness of the proposed method for assisting autism diagnosis. A receiver operating characteristic (ROC) curve metric is used to quantify the performance of the proposed method. The proposed method obtained promising results tested using real dataset provided by King Abdulaziz Hospital, Jeddah, Saudi Arabia. Ridha Djemal, Khalil AlSharabi, Sutrisno Ibrahim, and Abdullah Alsuwailem Copyright © 2017 Ridha Djemal et al. All rights reserved. Electrical Stimulation of Denervated Rat Skeletal Muscle Retards Capillary and Muscle Loss in Early Stages of Disuse Atrophy Thu, 13 Apr 2017 00:00:00 +0000 The purpose of the present study is to investigate the effects of low-frequency electrical muscle stimulation (ES) on the decrease in muscle mass, fiber size, capillary supply, and matrix metalloproteinase (MMP) immunoreactivity in the early stages of denervation-induced limb disuse. Direct ES was performed on the tibialis anterior muscle following denervation in seven-week-old male rats. The rats were divided into the following groups: control (CON), denervation (DN), and denervation with direct ES (DN + ES). Direct ES was performed at an intensity of 16 mA and a frequency of 10 Hz for 30 min per day, six days a week, for one week. We performed immunohistochemical staining to determine the expression of dystrophin, CD34, and MMP-2 in transverse sections of TA muscles. The weight, myofiber cross-sectional area (FCSA), and capillary-to-fiber (C/F) ratio of the tibialis anterior (TA) muscle were significantly reduced in the DN group compared to the control and DN + ES groups. The MMP-2 positive area was significantly greater in DN and DN + ES groups compared to the control group. These findings suggest beneficial effects of direct ES in reducing muscle atrophy and capillary regression without increasing MMP-2 immunoreactivity in the early stages of DN-induced muscle disuse in rat hind limbs. Kouki Nakagawa, Hiroyuki Tamaki, Keishi Hayao, Kengo Yotani, Futoshi Ogita, Noriaki Yamamoto, and Hideaki Onishi Copyright © 2017 Kouki Nakagawa et al. All rights reserved. Adaptations in Evoked Pain Sensitivity and Conditioned Pain Modulation after Development of Chronic Neck Pain Thu, 06 Apr 2017 00:00:00 +0000 Numerous studies demonstrate elevated pain sensitivity and impaired conditioned pain modulation (CPM) in patients with chronic musculoskeletal pain compared to healthy individuals; however, the time course of changes in pain sensitivity and CPM after the development of a chronic pain condition is unclear. Secondary analysis of data from a prospective investigation examined changes in evoked pain sensitivity and CPM before and after development of chronic neck pain (CNP). 171 healthy office workers participated in a baseline assessment, followed by monthly online questionnaires to identify those who developed CNP over the subsequent year. These individuals () and a cohort of participants () who remained pain-free during the follow-up period returned for a 12-month follow-up assessment of mechanical and thermal pain sensitivity and CPM. Pain sensitivity measures did not differ between groups at baseline; however, cold pain threshold decreased in the CNP group at follow-up (). CPM was lower at baseline in the CNP group compared to those who reported no neck pain () and remained unchanged one year later. These findings indicate that CPM is reduced in healthy individuals prior to the development of chronic neck pain and the subsequent reduction of thresholds for cold but not pressure pain. Bahar Shahidi and Katrina S. Maluf Copyright © 2017 Bahar Shahidi and Katrina S. Maluf. All rights reserved. Focal Muscle Vibration and Physical Exercise in Postmastectomy Recovery: An Explorative Study Sun, 26 Mar 2017 00:00:00 +0000 Background. Physical activity initiation and maintenance are particular challenges in the postmastectomy recovery and in particular Dragon Boat racing seems to be a useful sport activity. The aim of this study was to evaluate the role of focal muscle vibration as a proprioceptive input to improve upper limb functioning in a group of “paddlers” patients. Methods. A group of paddlers has been evaluated before vibratory treatment (T0), immediately after therapy (T1), after one week (T2), and after one month (T3) with DASH questionnaire, Body Image Scale, McGill pain questionnaire, Constant Scale, and Short Form 36 questionnaire. Results. Fourteen patients showed a significant reduction in disability score using DASH scale, an improvement of upper limb function using the Constant scale, and a reduction of pain at the McGill pain questionnaire. The Mental Composite Score of the Short Form 36 questionnaire showed significant results while no significant results had been found regarding the physical mental score . Conclusion. Focal muscle vibration may be a useful treatment in a postmastectomy recovery of upper limb functionality. Claudia Celletti, Maria Antonietta Fara, Guido Maria Filippi, Giuseppe La Torre, Roberto Tozzi, Nicola Vanacore, and Filippo Camerota Copyright © 2017 Claudia Celletti et al. All rights reserved. Evaluation of a Compact Hybrid Brain-Computer Interface System Wed, 08 Mar 2017 00:00:00 +0000 We realized a compact hybrid brain-computer interface (BCI) system by integrating a portable near-infrared spectroscopy (NIRS) device with an economical electroencephalography (EEG) system. The NIRS array was located on the subjects’ forehead, covering the prefrontal area. The EEG electrodes were distributed over the frontal, motor/temporal, and parietal areas. The experimental paradigm involved a Stroop word-picture matching test in combination with mental arithmetic (MA) and baseline (BL) tasks, in which the subjects were asked to perform either MA or BL in response to congruent or incongruent conditions, respectively. We compared the classification accuracies of each of the modalities (NIRS or EEG) with that of the hybrid system. We showed that the hybrid system outperforms the unimodal EEG and NIRS systems by 6.2% and 2.5%, respectively. Since the proposed hybrid system is based on portable platforms, it is not confined to a laboratory environment and has the potential to be used in real-life situations, such as in neurorehabilitation. Jaeyoung Shin, Klaus-Robert Müller, Christoph H. Schmitz, Do-Won Kim, and Han-Jeong Hwang Copyright © 2017 Jaeyoung Shin et al. All rights reserved. EMG Processing Based Measures of Fatigue Assessment during Manual Lifting Sun, 19 Feb 2017 00:00:00 +0000 Manual lifting is one of the common practices used in the industries to transport or move objects to a desired place. Nowadays, even though mechanized equipment is widely available, manual lifting is still considered as an essential way to perform material handling task. Improper lifting strategies may contribute to musculoskeletal disorders (MSDs), where overexertion contributes as the highest factor. To overcome this problem, electromyography (EMG) signal is used to monitor the workers’ muscle condition and to find maximum lifting load, lifting height and number of repetitions that the workers are able to handle before experiencing fatigue to avoid overexertion. Past researchers have introduced several EMG processing techniques and different EMG features that represent fatigue indices in time, frequency, and time-frequency domain. The impact of EMG processing based measures in fatigue assessment during manual lifting are reviewed in this paper. It is believed that this paper will greatly benefit researchers who need a bird’s eye view of the biosignal processing which are currently available, thus determining the best possible techniques for lifting applications. E. F. Shair, S. A. Ahmad, M. H. Marhaban, S. B. Mohd Tamrin, and A. R. Abdullah Copyright © 2017 E. F. Shair et al. All rights reserved. The Effect of Different Attentional Focus Instructions during Finger Movement Tasks in Healthy Subjects: An Exploratory Study Tue, 14 Feb 2017 00:00:00 +0000 External focus of attention (EFA) and internal focus of attention (IFA) represent commonly used strategies to instruct subjects during exercise. Several studies showed EFA to be more effective than IFA to improve motor performance and learning. To date the role of these strategies on motor performance during finger movement was less studied. The objective of the study was to investigate motor performance, patient’s preference induced by IFA and EFA, and the focus during control condition. Ten healthy right-handed participants performed a finger movement task in control, EFA, and IFA conditions (counterbalanced). Errors, patient’s preference, and type of attentional focus spontaneously adopted during the control condition were recorded. EFA determined less error () compared to control and IFA. Participants preferred EFA against IFA and control condition. In the control group 10% of subjects adopted a purely EFA, 70% of subjects adopted a purely IFA, and 20% of subjects adopted a mixture of the two foci. Our results confirm that EFA is more effective than IFA and control in finger movement task. Due its clinical relevance, the interaction between attention and finger movement should be further investigated. Giacomo Rossettini, Marco Testa, Marco Vicentini, and Paolo Manganotti Copyright © 2017 Giacomo Rossettini et al. All rights reserved. ArmAssist Robotic System versus Matched Conventional Therapy for Poststroke Upper Limb Rehabilitation: A Randomized Clinical Trial Tue, 31 Jan 2017 13:43:52 +0000 The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA) robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group ( each). Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) and Barthel index (BI). The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 ± 9.4 versus 7.5 ± 5.5, ) and WMFT-FAS score (14.1 ± 7.9 versus 6.7 ± 7.8, ) after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 ± 24.8 versus 13.1 ± 10.7, ). There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke. The study has been registered at the, ID: NCT02729649. Tijana J. Dimkić Tomić, Andrej M. Savić, Aleksandra S. Vidaković, Sindi Z. Rodić, Milica S. Isaković, Cristina Rodríguez-de-Pablo, Thierry Keller, and Ljubica M. Konstantinović Copyright © 2017 Tijana J. Dimkić Tomić et al. All rights reserved. Acute Feasibility of Neuromuscular Electrical Stimulation in Severely Obese Patients with Obstructive Sleep Apnea Syndrome: A Pilot Study Tue, 17 Jan 2017 00:00:00 +0000 Objective. Obesity and obstructive sleep apnea (OSA) are closely interconnected conditions both leading to high cardiovascular risk. Inactivity is frequent and physical activity programs remain difficult in these patients. We investigated the acute feasibility of two neuromuscular electrical stimulation (NMES) modalities in extremely inactive obese patients with OSA. Design. A randomized cross-over study, with two experimental sessions (one per condition: multipath NMES versus conventional NMES). Setting. Outpatient research hospital. Subjects. Twelve patients with obesity, already treated for OSA. Interventions. No intervention. Measures. Feasibility outcomes included NMES current intensity, knee extension force evoked by NMES, and self-reported discomfort. Results. We found higher current intensity, a trend to significantly higher evoked force and lower discomfort during multipath NMES versus conventional NMES, suggesting better tolerance to the former NMES modality. However, patients were rapidly limited in the potential of increasing current intensity of multipath NMES. Conclusion. Both NMES modalities were feasible and relatively well tolerated by obese patients with OSA, even if multipath NMES showed a better muscle response/discomfort ratio than conventional NMES. There is an urgent need for a proof-of-concept study and interventional randomized controlled trials comparing NMES therapy versus current care to justify its utilization in obese and apneic patients with low physical activity levels. Isabelle Vivodtzev, Nicola A. Maffiuletti, Anne-Laure Borel, Angélique Grangier, Bernard Wuyam, Renaud Tamisier, and Jean-Louis Pépin Copyright © 2017 Isabelle Vivodtzev et al. All rights reserved. Patient-Centered Robot-Aided Passive Neurorehabilitation Exercise Based on Safety-Motion Decision-Making Mechanism Mon, 16 Jan 2017 00:00:00 +0000 Safety is one of the crucial issues for robot-aided neurorehabilitation exercise. When it comes to the passive rehabilitation training for stroke patients, the existing control strategies are usually just based on position control to carry out the training, and the patient is out of the controller. However, to some extent, the patient should be taken as a “cooperator” of the training activity, and the movement speed and range of the training movement should be dynamically regulated according to the internal or external state of the subject, just as what the therapist does in clinical therapy. This research presents a novel motion control strategy for patient-centered robot-aided passive neurorehabilitation exercise from the point of the safety. The safety-motion decision-making mechanism is developed to online observe and assess the physical state of training impaired-limb and motion performances and regulate the training parameters (motion speed and training rage), ensuring the safety of the supplied rehabilitation exercise. Meanwhile, position-based impedance control is employed to realize the trajectory tracking motion with interactive compliance. Functional experiments and clinical experiments are investigated with a healthy adult and four recruited stroke patients, respectively. The two types of experimental results demonstrate that the suggested control strategy not only serves with safety-motion training but also presents rehabilitation efficacy. Lizheng Pan, Aiguo Song, Suolin Duan, and Zhuqing Yu Copyright © 2017 Lizheng Pan et al. All rights reserved. The Influence of the “Straighten Your Back” Command on the Sagittal Spinal Curvatures in Children with Generalized Joint Hypermobility Sun, 01 Jan 2017 13:36:19 +0000 Objectives. The aim of the study was to assess the change of sagittal spinal curvatures in children with generalized joint hypermobility (GJH) instructed with “straighten your back” command (SYB). Methods. The study included 56 children with GJH. The control group consisted of 193 children. Sacral slope (SS), lumbar lordosis (LL), global thoracic kyphosis (TK), lower thoracic kyphosis (LK), and upper thoracic kyphosis (UK) were assessed with Saunders inclinometer both in spontaneous positions (standing and sitting) and after the SYB. Results. Children with GJH after SYB presented the following: in standing, increase in SS and decrease in TK, LK, and UK (), with LL not significantly changed; in sitting: decrease in global thoracic kyphosis (35.5° (SD 20.5) versus 21.0° (SD 15.5), ) below the standards proposed in the literature (30–40°) and flattening of its lower part (). The same changes were observed in the control group. Conclusions. In children with generalized joint hypermobility, the “straighten your back” command leads to excessive reduction of the global thoracic kyphosis and flattening of its lower part. Therefore, the “straighten your back” command should not be used to achieve the optimal standing and sitting positions. Dariusz Czaprowski, Paulina Pawłowska, Aleksandra Kolwicz-Gańko, Dominik Sitarski, and Agnieszka Kędra Copyright © 2017 Dariusz Czaprowski et al. All rights reserved. Rehabilitation Training and Resveratrol Improve the Recovery of Neurological and Motor Function in Rats after Cerebral Ischemic Injury through the Sirt1 Signaling Pathway Tue, 27 Dec 2016 12:58:47 +0000 This study was conducted to investigate the recovery of motor function in rats through the silent information regulator factor 2-related enzyme 1 (Sirt1) signal pathway-mediated rehabilitation training. Middle cerebral artery occlusion (MACO) was used to induce ischemia/reperfusion injury. The rats were subjected to no treatment (model), rehabilitation training (for 21 days), resveratrol (5 mg/kg for 21 days), and rehabilitation training plus resveratrol treatment. 24 h later, They were assessed for neurobehavioral score and motor behavior score and expression of brain derived-nerve neurotrophic factor (BDNF) and tyrosine kinase receptor B (TrkB). Compared with sham group, models had significantly higher neurobehavioral scores, balance beam, and rotary stick scores. Compared with the model group, rats in rehabilitation training and resveratrol groups had significantly reduced scores. Compared with rehabilitation training or resveratrol treatment alone, rehabilitation plus resveratrol further reduced the scores significantly. The percentage of cells expressing BDNF and TrkB and expression levels of BDNF and TrkB were similar between the model and sham groups, significantly increased in rehabilitation training and resveratrol groups, and further increased in rehabilitation training plus resveratrol group. These results indicate that rehabilitation raining plus resveratrol can significantly improve the recovery of motor function in rats after cerebral ischemic injury, which is likely related to the upregulation of the BDNF/TrkB signaling pathway. Na Shi, Chongtian Zhu, and Liying Li Copyright © 2016 Na Shi et al. All rights reserved. A New Neurocognitive Interpretation of Shoulder Position Sense during Reaching: Unexpected Competence in the Measurement of Extracorporeal Space Sun, 25 Dec 2016 11:51:17 +0000 Background. The position sense of the shoulder joint is important during reaching. Objective. To examine the existence of additional competence of the shoulder with regard to the ability to measure extracorporeal space, through a novel approach, using the shoulder proprioceptive rehabilitation tool (SPRT), during reaching. Design. Observational case-control study. Methods. We examined 50 subjects: 25 healthy and 25 with impingement syndrome with a mean age [years] of 64.52 +/− 6.98 and 68.36 +/− 6.54, respectively. Two parameters were evaluated using the SPRT: the integration of visual information and the proprioceptive afferents of the shoulder (Test 1) and the discriminative proprioceptive capacity of the shoulder, with the subject blindfolded (Test 2). These tasks assessed the spatial error (in centimeters) by the shoulder joint in reaching movements on the sagittal plane. Results. The shoulder had proprioceptive features that allowed it to memorize a reaching position and reproduce it (error of 1.22 cm to 1.55 cm in healthy subjects). This ability was lower in the impingement group, with a statistically significant difference compared to the healthy group ( by Mann–Whitney test). Conclusions. The shoulder has specific expertise in the measurement of the extracorporeal space during reaching movements that gradually decreases in impingement syndrome. Teresa Paolucci, Federico Zangrando, Giulia Piccinini, Federico Sciarra, Rocco Pallotta, Alice Mannocci, Giuseppe la Torre, Fabiano Bini, Franco Marinozzi, Stefano Gumina, Luca Padua, and Vincenzo Maria Saraceni Copyright © 2016 Teresa Paolucci et al. All rights reserved. Vowel Imagery Decoding toward Silent Speech BCI Using Extreme Learning Machine with Electroencephalogram Mon, 19 Dec 2016 13:22:32 +0000 The purpose of this study is to classify EEG data on imagined speech in a single trial. We recorded EEG data while five subjects imagined different vowels, /a/, /e/, /i/, /o/, and /u/. We divided each single trial dataset into thirty segments and extracted features (mean, variance, standard deviation, and skewness) from all segments. To reduce the dimension of the feature vector, we applied a feature selection algorithm based on the sparse regression model. These features were classified using a support vector machine with a radial basis function kernel, an extreme learning machine, and two variants of an extreme learning machine with different kernels. Because each single trial consisted of thirty segments, our algorithm decided the label of the single trial by selecting the most frequent output among the outputs of the thirty segments. As a result, we observed that the extreme learning machine and its variants achieved better classification rates than the support vector machine with a radial basis function kernel and linear discrimination analysis. Thus, our results suggested that EEG responses to imagined speech could be successfully classified in a single trial using an extreme learning machine with a radial basis function and linear kernel. This study with classification of imagined speech might contribute to the development of silent speech BCI systems. Beomjun Min, Jongin Kim, Hyeong-jun Park, and Boreom Lee Copyright © 2016 Beomjun Min et al. All rights reserved. Integrative Evaluation of Automated Massage Combined with Thermotherapy: Physical, Physiological, and Psychological Viewpoints Thu, 15 Dec 2016 09:39:14 +0000 Various types of massages are reported to relieve stress, pain, and anxiety which are beneficial for rehabilitation; however, more comprehensive studies are needed to understand the mechanism of massage therapy. In this study, we investigated the effect of massage therapy, alone or in combination with infrared heating, on 3 different aspects: physical, physiological, and psychological. Twenty-eight healthy university students were subjected to 3 different treatment conditions on separate days, one condition per day: control, massage only, or massage with infrared heating. Physical (trunk extension [TE]; maximum power of erector spinae), physiological (heart-rate variability [HRV]; electroencephalogram [EEG]), and psychological (state-trait anxiety inventory [STAI]; visual analogue scale [VAS]) measurements were evaluated and recorded before and after each treatment condition. The results showed that massage therapy, especially when combined with infrared heating, significantly improved physical functioning, increased parasympathetic response, and decreased psychological stress and anxiety. In the current study, we observed that massage therapy contributes to various physical, physiological, and psychological changes, where the effect increases with thermotherapy. Do-Won Kim, Dae Woon Lee, Joergen Schreiber, Chang-Hwan Im, and Hansung Kim Copyright © 2016 Do-Won Kim et al. All rights reserved. Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review Wed, 07 Dec 2016 06:06:06 +0000 Objective. To critically evaluate the studies that were conducted over the past 10 years and to assess the impact of virtual reality on static and dynamic balance control in the stroke population. Method. A systematic review of randomized controlled trials published between January 2006 and December 2015 was conducted. Databases searched were PubMed, Scopus, and Web of Science. Studies must have involved adult patients with stroke during acute, subacute, or chronic phase. All included studies must have assessed the impact of virtual reality programme on either static or dynamic balance ability and compared it with a control group. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. Results. Nine studies were included in this systematic review. The PEDro scores ranged from 4 to 9 points. All studies, except one, showed significant improvement in static or dynamic balance outcomes group. Conclusions. This review provided moderate evidence to support the fact that virtual reality training is an effective adjunct to standard rehabilitation programme to improve balance for patients with chronic stroke. The effect of VR training in balance recovery is less clear in patients with acute or subacute stroke. Further research is required to investigate the optimum training intensity and frequency to achieve the desired outcome. Ling Chen, Wai Leung Ambrose Lo, Yu Rong Mao, Ming Hui Ding, Qiang Lin, Hai Li, Jiang Li Zhao, Zhi Qin Xu, Rui Hao Bian, and Dong Feng Huang Copyright © 2016 Ling Chen et al. All rights reserved. Approaches in Physical Activity: From Basic to Applied Research Sun, 04 Dec 2016 13:59:06 +0000 Julien S. Baker, Leonardo dos Santos, Bruce Davies, Emmanuel G. Ciolac, and Danilo S. Bocalini Copyright © 2016 Julien S. Baker et al. All rights reserved. Experimental Verification of Modeled Thermal Distribution Produced by a Piston Source in Physiotherapy Ultrasound Wed, 23 Nov 2016 12:43:16 +0000 Objectives. To present a quantitative comparison of thermal patterns produced by the piston-in-a-baffle approach with those generated by a physiotherapy ultrasonic device and to show the dependency among thermal patterns and acoustic intensity distributions. Methods. The finite element (FE) method was used to model an ideal acoustic field and the produced thermal pattern to be compared with the experimental acoustic and temperature distributions produced by a real ultrasonic applicator. A thermal model using the measured acoustic profile as input is also presented for comparison. Temperature measurements were carried out with thermocouples inserted in muscle phantom. The insertion place of thermocouples was monitored with ultrasound imaging. Results. Modeled and measured thermal profiles were compared within the first 10 cm of depth. The ideal acoustic field did not adequately represent the measured field having different temperature profiles (errors 10% to 20%). Experimental field was concentrated near the transducer producing a region with higher temperatures, while the modeled ideal temperature was linearly distributed along the depth. The error was reduced to 7% when introducing the measured acoustic field as the input variable in the FE temperature modeling. Conclusions. Temperature distributions are strongly related to the acoustic field distributions. M. I. Gutierrez, S. A. Lopez-Haro, A. Vera, and L. Leija Copyright © 2016 M. I. Gutierrez et al. All rights reserved. Effect of Anodal-tDCS on Event-Related Potentials: A Controlled Study Thu, 10 Nov 2016 06:08:40 +0000 We aim to measure the postintervention effects of A-tDCS (anodal-tDCS) on brain potentials commonly used in BCI applications, namely, Event-Related Desynchronization (ERD), Event-Related Synchronization (ERS), and P300. Ten subjects were given sham and 1.5 mA A-tDCS for 15 minutes on two separate experiments in a double-blind, randomized order. Postintervention EEG was recorded while subjects were asked to perform a spelling task based on the “oddball paradigm” while P300 power was measured. Additionally, ERD and ERS were measured while subjects performed mental motor imagery tasks. ANOVA results showed that the absolute P300 power exhibited a statistically significant difference between sham and A-tDCS when measured over channel Pz (). However, the difference in ERD and ERS power was found to be statistically insignificant, in controversion of the the mainstay of the litrature on the subject. The outcomes confirm the possible postintervention effect of tDCS on the P300 response. Heightening P300 response using A-tDCS may help improve the accuracy of P300 spellers for neurologically impaired subjects. Additionally, it may help the development of neurorehabilitation methods targeting the parietal lobe. Ahmed Izzidien, Sriharasha Ramaraju, Mohammed Ali Roula, and Peter W. McCarthy Copyright © 2016 Ahmed Izzidien et al. All rights reserved. Effects of Tactile Sensitivity on Structural Variability of Digit Forces during Stable Precision Grip Tue, 25 Oct 2016 13:31:14 +0000 This study investigated the effects of fingertip tactile sensitivity on the structural variability of thumb and index finger forces during stable precision grip. Thirty right-handed healthy subjects participated in the experiment. Transient perturbation of tactile afferents was achieved by wrapping up the distal pads of the thumb or index finger with transparent polyethylene films. The time-dependent structure of each digit force and the variability of interdigit force correlation were examined by detrended fluctuation analysis (DFA) and detrended cross-correlation analysis (DCCA), respectively. Results showed that the tactile sensitivity affected of the vertical shear force ( = 6.814, ) and of ( = 16.440, ). No significant difference was observed in or of the normal forces produced by the thumb or index finger. These results suggested that with blurred tactile sensory inputs the central nervous system might decrease the vertical shear force flexibility and increase the interdigit shear force coupling in order to guarantee a stable grip control of an object against gravity. This study shed light on the feedback and feed-forward strategies involved in digit force control and the role of SA-II afferent fibers in regulation of vertical shear force variability for precision grip. Ke Li, Na Wei, and Shouwei Yue Copyright © 2016 Ke Li et al. All rights reserved. The Impact of Walking Exercises and Resistance Training upon the Walking Distance in Patients with Chronic Lower Limb Ischaemia Wed, 19 Oct 2016 08:33:04 +0000 Objective. The objective of this paper is to compare the impact of supervised walking and resistance training upon the walking distance in PAD patients. Materials and Methods. The examination involved 50 PAD patients at the 2nd stage of the disease according to Fontaine’s scale. The participants were randomly allocated to two groups: one exercising on the treadmill () and one performing resistance exercises of lower limbs (). Results. The 12-week program of supervised rehabilitation led to a significant increase in the intermittent claudication distance measured both on the treadmill and during the 6-minute walking test. The group training on the treadmill showed a statistically significant increase of the initial claudication distance (ICD) and the absolute claudication distance (ACD) measured on the treadmill, as well as of ICD and the total walking distance (TWD) measured during the 6-minute walking test. Within the group performing resistance exercises, a statistically significant improvement was observed in the case of parameters measured on the treadmill: ICD and ACD. Conclusions. The supervised rehabilitation program, in the form of both walking and resistance exercises, contributes to the increase in the intermittent claudication distance. The results obtained in both groups were similar. Maria Szymczak, Grzegorz Oszkinis, and Marian Majchrzycki Copyright © 2016 Maria Szymczak et al. All rights reserved. Strength Training Improves Fatigue Resistance and Self-Rated Health in Workers with Chronic Pain: A Randomized Controlled Trial Mon, 17 Oct 2016 09:30:04 +0000 Chronic musculoskeletal pain is widespread in the working population and leads to muscular fatigue, reduced work capacity, and fear of movement. While ergonomic intervention is the traditional approach to the problem, physical exercise may be an alternative strategy. This secondary analysis of a randomized controlled trial investigates the effect of strength training on muscular fatigue resistance and self-rated health among workers with chronic pain. Sixty-six slaughterhouse workers with chronic upper limb pain and work disability were randomly allocated to 10 weeks of strength training or usual care ergonomic training (control). At baseline and follow-up, participants performed a handgrip muscular fatigue test (time above 50% of maximal voluntary contraction force) with simultaneous recording of electromyography. Additionally, participants replied to a questionnaire regarding self-rated health and pain. Time to fatigue, muscle strength, hand/wrist pain, and self-rated health improved significantly more following strength training than usual care (all ). Time to fatigue increased by 97% following strength training and this change was correlated to the reduction in fear avoidance (Spearman’s rho ; ). In conclusion, specific strength training improves muscular fatigue resistance and self-rated health and reduces pain of the hand/wrist in manual workers with chronic upper limb pain. This trial is registered with NCT01671267. Emil Sundstrup, Markus Due Jakobsen, Mikkel Brandt, Kenneth Jay, Per Aagaard, and Lars Louis Andersen Copyright © 2016 Emil Sundstrup et al. All rights reserved. Exercise Alters Gait Pattern but Not Knee Load in Patients with Knee Osteoarthritis Tue, 20 Sep 2016 16:47:54 +0000 Six female patients with bilateral medial knee OA and 6 healthy controls were recruited. Patients with knee OA received a 6-week physiotherapist-supervised and home-based exercise program. Outcome measures, including the Western Ontario and McMaster Universities Arthritis Index and Short Form-36 Health Survey as well as objective biomechanical indices were obtained at baseline and follow-up. After treatment, no significant difference was observed in the knee abductor moment (KAM), lever arm, and ground reaction force. We, however, observed significantly improved pain and physical function as well as altered gait patterns, including a higher hip flexor moment and hip extension angle with a faster walking speed. Although KAM was unchanged, patients with bilateral knee OA showed an improved walking speed and altered the gait pattern after 6 weeks of supervised exercise. This finding suggests that the exercise intervention improves proximal joint mechanics during walking and can be considered for patients with bilateral knee OA. Non-weight-bearing strengthening without external resistance combined with stretching exercise may be an option to improve pain and function in individuals with OA who cannot perform high resistance exercises owing to pain or other reasons. Ssu-Yu Chang, Yi-Jia Lin, Wei-Chun Hsu, Lin-Fen Hsieh, Yuan-Hsiang Lin, Chao-Chin Chang, You-Cai Chou, and Li-Fei Chen Copyright © 2016 Ssu-Yu Chang et al. All rights reserved. Analysis of the Influence of Complexity and Entropy of Odorant on Fractal Dynamics and Entropy of EEG Signal Thu, 08 Sep 2016 17:48:25 +0000 An important challenge in brain research is to make out the relation between the features of olfactory stimuli and the electroencephalogram (EEG) signal. Yet, no one has discovered any relation between the structures of olfactory stimuli and the EEG signal. This study investigates the relation between the structures of EEG signal and the olfactory stimulus (odorant). We show that the complexity of the EEG signal is coupled with the molecular complexity of the odorant, where more structurally complex odorant causes less fractal EEG signal. Also, odorant having higher entropy causes the EEG signal to have lower approximate entropy. The method discussed here can be applied and investigated in case of patients with brain diseases as the rehabilitation purpose. Hamidreza Namazi, Amin Akrami, Sina Nazeri, and Vladimir V. Kulish Copyright © 2016 Hamidreza Namazi et al. All rights reserved. A Systematised Review of Primary School Whole Class Child Obesity Interventions: Effectiveness, Characteristics, and Strategies Wed, 07 Sep 2016 14:22:29 +0000 Background. A systematised review was conducted to examine the effectiveness of school-based interventions that focus on changing dietary intake and physical activity levels to reduce childhood obesity. Methods. Multiple databases were searched for randomised and nonrandomised interventions from 2007 to 2016 in full-time elementary schools, which were delivered to the whole class, included dietary and physical activity components, involved both sexes, were written in English, and used body mass index (BMI) as an outcome. Results. The database search produced 8,866 titles from which 78 were deemed relevant and assessed for inclusion resulting in 15 studies meeting all inclusion criteria. From these 15 studies, 9 yielded a reduction or stabilisation in BMI or BMI -score in the entire intervention group and/or subgroups. Programmes lasting between 6 and 12 months that involve multiple environmental, educational, and physical strategies appear to be most likely to result in BMI or BMI -score improvement. Moderators most likely influencing an improvement in BMI included increased physical activity, decreased sugar sweetened beverages intake, and increased fruit intake. Conclusions. School-based interventions may be an effective means for child obesity prevention. The identification of consistent elements used in school-based interventions that have demonstrated effectiveness may aid in preventing child obesity. Elise C. Brown, Duncan S. Buchan, Julien S. Baker, Frank B. Wyatt, Danilo S. Bocalini, and Lon Kilgore Copyright © 2016 Elise C. Brown et al. All rights reserved. Effect of Dissection and Reconstruction of Palatal Muscles on Morphological Features and Ultrastructure of the Oral Musculature in Cats Tue, 06 Sep 2016 14:19:57 +0000 The study was designed to determine the effect of dissection and reconstruction of palatal muscles on muscle morphology in cats. 27 cats were randomly divided into three groups according to the extent of muscle dissection from the palatal midline. All dissections were performed from the posterior border of the hard palate, and the muscles were allowed to reconstruct over time. The morphological features were determined by hematoxylin and eosin staining of tissue sections, and ultrastructure was observed under a transmission electron microscope. As a result, no obvious differences were evident in the morphological features or ultrastructure of animals in the <1/3rd and 1/3rd-2/3rd area groups. In the >2/3rd area group, the muscles fibers were disordered and inflammatory cell infiltration and naïve muscle cells were found at one month after surgery. At the second and third month after surgery, the muscle fibers showed regular alignment, the naïve muscle fibers gradually matured, and the number of infiltrating inflammatory cells decreased. Muscle ultrastructure analysis revealed that myocommata were correctly aligned, and the Z line was more distinct. In conclusion, extensive dissection of palatal muscles does not result in fibrosis. Injury to oral musculature can be repaired and the musculature regenerated over time. Wei Han, Zhiyong Wang, Xiaofeng Qi, Wenguang Xu, Hao Shen, Bing Shi, and Yong Lu Copyright © 2016 Wei Han et al. All rights reserved. Motor Ingredients Derived from a Wearable Sensor-Based Virtual Reality System for Frozen Shoulder Rehabilitation Tue, 23 Aug 2016 14:41:15 +0000 Objective. This study aims to extract motor ingredients through data mining from wearable sensors in a virtual reality goal-directed shoulder rehabilitation (GDSR) system and to examine their effects toward clinical assessment. Design. A single-group before/after comparison. Setting. Outpatient research hospital. Subjects. 16 patients with frozen shoulder. Interventions. The rehabilitation treatment involved GDSR exercises, hot pack, and interferential therapy. All patients first received hot pack and interferential therapy on the shoulder joints before engaging in the exercises. The GDSR exercise sessions were 40 minutes twice a week for 4 weeks. Main Measures. Clinical assessments included Constant and Murley score, range of motion of the shoulder, and muscle strength of upper arm as main measures. Motor indices from sensor data and task performance were measured as secondary measures. Results. The pre- and posttest results for task performance, motor indices, and the clinical assessments indicated significant improvement for the majority of the assessed items. Correlation analysis between the task performance and clinical assessments revealed significant correlations among a number of items. Stepwise regression analysis showed that task performance effectively predicted the results of several clinical assessment items. Conclusions. The motor ingredients derived from the wearable sensor and task performance are applicable and adequate to examine and predict clinical improvement after GDSR training. Si-Huei Lee, Shih-Ching Yeh, Rai-Chi Chan, Shuya Chen, Geng Yang, and Li-Rong Zheng Copyright © 2016 Si-Huei Lee et al. All rights reserved. Data-Driven User Feedback: An Improved Neurofeedback Strategy considering the Interindividual Variability of EEG Features Thu, 18 Aug 2016 15:59:59 +0000 It has frequently been reported that some users of conventional neurofeedback systems can experience only a small portion of the total feedback range due to the large interindividual variability of EEG features. In this study, we proposed a data-driven neurofeedback strategy considering the individual variability of electroencephalography (EEG) features to permit users of the neurofeedback system to experience a wider range of auditory or visual feedback without a customization process. The main idea of the proposed strategy is to adjust the ranges of each feedback level using the density in the offline EEG database acquired from a group of individuals. Twenty-two healthy subjects participated in offline experiments to construct an EEG database, and five subjects participated in online experiments to validate the performance of the proposed data-driven user feedback strategy. Using the optimized bin sizes, the number of feedback levels that each individual experienced was significantly increased to 139% and 144% of the original results with uniform bin sizes in the offline and online experiments, respectively. Our results demonstrated that the use of our data-driven neurofeedback strategy could effectively increase the overall range of feedback levels that each individual experienced during neurofeedback training. Chang-Hee Han, Jeong-Hwan Lim, Jun-Hak Lee, Kangsan Kim, and Chang-Hwan Im Copyright © 2016 Chang-Hee Han et al. All rights reserved. Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction Wed, 17 Aug 2016 13:51:17 +0000 Objective. Results of a device-training for nonambulatory individuals with thoracic and lumbar spinal cord injury (SCI) using a powered exoskeleton for technically assisted mobility with regard to the achieved level of control of the system after training, user satisfaction, and effects on quality of life (QoL). Methods. Observational single centre study with a 4-week to 5-week intensive inpatient device-training using a powered exoskeleton (ReWalk™). Results. All 7 individuals with SCI who commenced the device-training completed the course of training and achieved basic competences to use the system, that is, the ability to stand up, sit down, keep balance while standing, and walk indoors, at least with a close contact guard. User satisfaction with the system and device-training was documented for several aspects. The quality of life evaluation (SF-12v2™) indicated that the use of the powered exoskeleton can have positive effects on the perception of individuals with SCI regarding what they can achieve physically. Few adverse events were observed: minor skin lesions and irritations were observed; no falls occurred. Conclusions. The device-training for individuals with thoracic and lumbar SCI was effective and safe. All trained individuals achieved technically assisted mobility with the exoskeleton while still needing a close contact guard. Thomas Platz, Annett Gillner, Nicole Borgwaldt, Sylvia Kroll, and Sybille Roschka Copyright © 2016 Thomas Platz et al. All rights reserved. Lower Limb Loading during Gait in Patients Long Period after Total Hip Arthroplasty Revision Thu, 04 Aug 2016 09:59:27 +0000 The aim of the study was to assess lower limb loading during walking after unilateral total hip arthroplasty (THA) revision. Twenty-three THA revision subjects (12 men, 11 women) were divided into three groups according to time since surgery as 1 to 6 years, 6 to 11 years, and over 11 years. Two force plates were used to measure the ground reaction force during the stance phase. On the operated limb, compared to nonoperated limb, we found lower first vertical peak in the group of 1 to 6 years after revision and lower propulsion peak in the group of 6 to 11 years since revision. In the group of 11 years since THA revision, no significant difference was found. With advancing years after surgery, the stance phase duration got reduced and propulsion peak increased in the operated limb; minimal vertical force decreased and the time of minimal vertical force increased in the nonoperated limb. The study findings suggest the tendency to a more gradual and safer weight acceptance on the operated limb during the first years after THA revision, followed by limitation of foot propulsion. Despite this fact, lower limb loading can be considered as symmetrical across the whole measured period. Eliska Kubonova, Zdenek Svoboda, Miroslav Janura, Jiri Gallo, and Sarka Duskova Copyright © 2016 Eliska Kubonova et al. All rights reserved. Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review Wed, 20 Jul 2016 16:41:24 +0000 Purpose. The aim of this paper is to review the published studies on the characteristics of impairments in the postural control and gait performance in diabetic peripheral neuropathy (DPN). Methods. A review was performed by obtaining publication of all papers reporting on the postural control and gait performance in DPN from Google Scholar, Ovid, SAGE, Springerlink, Science Direct (SD), EBSCO Discovery Service, and Web of Science databases. The keywords used for searching were “postural control,” “balance,” “gait performance,” “diabetes mellitus,” and “diabetic peripheral neuropathy.” Results. Total of 4,337 studies were hit in the search. 1,524 studies were screened on their titles and citations. Then, 79 studies were screened on their abstract. Only 38 studies were eligible to be selected: 17 studies on postural control and 21 studies on the gait performance. Most previous researches were found to have strong evidence of postural control impairments and noticeable gait deficits in DPN. Deterioration of somatosensory, visual, and vestibular systems with the pathologic condition of diabetes on cognitive impairment causes further instability of postural and gait performance in DPN. Conclusions. Postural instability and gait imbalance in DPN may contribute to high risk of fall incidence, especially in the geriatric population. Thus, further works are crucial to highlight this fact in the hospital based and community adults. Amirah Mustapa, Maria Justine, Nadia Mohd Mustafah, Nursuriati Jamil, and Haidzir Manaf Copyright © 2016 Amirah Mustapa et al. All rights reserved. Effects of Arm Weight Support Training to Promote Recovery of Upper Limb Function for Subacute Patients after Stroke with Different Levels of Arm Impairments Tue, 19 Jul 2016 13:43:29 +0000 Purpose. The goal of this study was to investigate the effects of arm weight support training using the ArmeoSpring for subacute patients after stroke with different levels of hemiplegic arm impairments. Methods. 48 inpatients with subacute stroke, stratified into 3 groups from mild to severe upper extremity impairment, were engaged in ArmeoSpring training for 45 minutes daily, 5 days per week for 3 weeks, in addition to conventional rehabilitation. Evaluations were conducted at three measurement occasions: immediately before training (T1); immediately after training (T2); and at a 3-week follow-up (T3) by a blind rater. Results. Shoulder flexion active range of motion, Upper Extremity Scores in the Fugl-Meyer Assessment (FMA), and Vertical Catch had the greatest differences in gain scores for patients between severe and moderate impairments, whereas FMA Hand Scores had significant differences in gain scores between moderate and mild impairments. There was no significant change in muscle tone or hand-path ratios between T1, T2, and T3 within the groups. Conclusion. Arm weight support training is beneficial for subacute stroke patients with moderate to severe arm impairments, especially to improve vertical control such as shoulder flexion, and there were no adverse effects in muscle tone. Irene H. L. Chan, Kenneth N. K. Fong, Dora Y. L. Chan, Apple Q. L. Wang, Eddy K. N. Cheng, Pinky H. Y. Chau, Kathy K. Y. Chow, and Hobby K. Y. Cheung Copyright © 2016 Irene H. L. Chan et al. All rights reserved. Energetic Assessment of the Nonexercise Activities under Free-Living Conditions Thu, 14 Jul 2016 09:36:26 +0000 Nonexercise activities (NAs) are common types of physical activity in daily life and critical component in energy expenditure. However, energetic assessment of NA, particularly in free-living subjects, is a technical challenge. In this study, mechanical modeling and portable device were used to evaluate five common types of NA in daily life: sit to stand, lie to sit, bowing while standing, squat, and right leg over left. A human indirect calorimeter was used to measure the activity energy expenditure of NA. Mechanical work and mechanical efficiency of NA were calculated for mechanical modeling. Thirty-two male subjects were recruited for the study (20 subjects for the development of models and 12 subjects for evaluation of models). The average (mean ± SD) mechanical work of 5 NAs was 2.31 ± 0.50, 2.88 ± 0.57, 1.75 ± 0.55, 3.96 ± 1.25, and 1.25 ± 0.51 J/kg·m, respectively. The mean mechanical efficiencies of those activities were 22.0 ± 3.3%, 26.5 ± 5.1%, 19.8 ± 3.7%, 24.0 ± 5.5%, and 26.3 ± 5.5%. The activity energy expenditure estimated by the models was not significantly different from the measurements by the calorimeter () with accuracies of 102.2 ± 20.7%, 103.7 ± 25.8%, 105.6 ± 14.6%, 101.1 ± 28.0%, and 95.8 ± 20.7%, respectively, for those activities. These findings suggest that the mechanical models combined with a portable device can provide an alternative method for the energetic analysis of nonexercise activities under free-living condition. Shijie Sun, Qiang Tang, Haiying Quan, Qi Lu, Ming Sun, and Kuan Zhang Copyright © 2016 Shijie Sun et al. All rights reserved. Effect of Regular Resistance Training on Motivation, Self-Perceived Health, and Quality of Life in Previously Inactive Overweight Women: A Randomized, Controlled Trial Mon, 04 Jul 2016 10:19:45 +0000 Objectives. The aim was to investigate the effects of three different types of resistance training implementation. Design. Randomized controlled trial. Methods. Inactive, overweight women (), mean BMI  kg/m2, mean age years, were randomized to one of the following groups: A (BodyPump group training), B (individual follow-up by a personal trainer), C (nonsupervised exercise), or D (controls). The intervention included 12 weeks of 45–60 minutes’ full-body resistance training three sessions per week. The outcomes in this paper are all secondary outcome measures: exercise motivation, self-perceived health, and quality of life. Results. Adherence averaged of 36 prescribed sessions. After the intervention period, all three training groups (A–C) had better scores on exercise motivation (, , ) compared to the control group (D) () (). Groups B and C scored better on self-perceived health (, ), compared to group D () (). For quality of life measurement, there was no statistically significant difference between either intervention groups or the control. Conclusions. Resistance training contributed to higher scores in important variables related to exercise motivation and self-perceived health. Low adherence showed that it was difficult to motivate previously inactive, overweight women to participate in regular strength training. Hege Heiestad, Anne Mette Rustaden, Kari Bø, and Lene A. H. Haakstad Copyright © 2016 Hege Heiestad et al. All rights reserved. Evaluating a Nationwide Recreational Football Intervention: Recruitment, Attendance, Adherence, Exercise Intensity, and Health Effects Wed, 29 Jun 2016 09:28:09 +0000 The present study evaluated a nationwide exercise intervention with Football Fitness in a small-scale society. In all, 741 adult participants (20–72 yrs) were successfully recruited for Football Fitness training in local football clubs, corresponding to 2.1% of the adult population. A preintervention test battery including resting heart rate (RHR), blood pressure, and body mass measurements along with performance tests (Yo-Yo Intermittent Endurance level 1 (Yo-Yo IE1), the Arrowhead Agility Test, and the Flamingo Balance Test) were performed (). Training attendance () was 1.6 ± 0.2 sessions per week (range: 0.6–2.9), corresponding to 28.8 ± 1.0 sessions during the 18 wk intervention period. After 18 wks mean arterial pressure (MAP) was −2.7 ± 0.7 mmHg lower (; ) with even greater () reductions for those with baseline MAP values >99 mmHg (−5.6 ± 1.5 mmHg; ). RHR was lowered () by 6 bpm after intervention (77 ± 1 to 71 ± 1 bpm). Yo-Yo IE1 performance increased by 41% (540 ± 27 to 752 ± 45 m), while agility and postural balance were improved () by ~6 and ~45%, respectively. In conclusion, Football Fitness was shown to be a successful health-promoting nationwide training intervention for adult participants with an extraordinary recruitment, a high attendance rate, moderate adherence, high exercise intensity, and marked benefits in cardiovascular health profile and fitness. Liljan av Fløtum, Laila S. Ottesen, Peter Krustrup, and Magni Mohr Copyright © 2016 Liljan av Fløtum et al. All rights reserved. Inverse Kinematics for Upper Limb Compound Movement Estimation in Exoskeleton-Assisted Rehabilitation Wed, 15 Jun 2016 12:04:48 +0000 Robot-Assisted Rehabilitation (RAR) is relevant for treating patients affected by nervous system injuries (e.g., stroke and spinal cord injury). The accurate estimation of the joint angles of the patient limbs in RAR is critical to assess the patient improvement. The economical prevalent method to estimate the patient posture in Exoskeleton-based RAR is to approximate the limb joint angles with the ones of the Exoskeleton. This approximation is rough since their kinematic structures differ. Motion capture systems (MOCAPs) can improve the estimations, at the expenses of a considerable overload of the therapy setup. Alternatively, the Extended Inverse Kinematics Posture Estimation (EIKPE) computational method models the limb and Exoskeleton as differing parallel kinematic chains. EIKPE has been tested with single DOF movements of the wrist and elbow joints. This paper presents the assessment of EIKPE with elbow-shoulder compound movements (i.e., object prehension). Ground-truth for estimation assessment is obtained from an optical MOCAP (not intended for the treatment stage). The assessment shows EIKPE rendering a good numerical approximation of the actual posture during the compound movement execution, especially for the shoulder joint angles. This work opens the horizon for clinical studies with patient groups, Exoskeleton models, and movements types. Camilo Cortés, Ana de los Reyes-Guzmán, Davide Scorza, Álvaro Bertelsen, Eduardo Carrasco, Ángel Gil-Agudo, Oscar Ruiz-Salguero, and Julián Flórez Copyright © 2016 Camilo Cortés et al. All rights reserved. Influencing Factors on the Overestimation of Self-Reported Physical Activity: A Cross-Sectional Analysis of Low Back Pain Patients and Healthy Controls Thu, 19 May 2016 11:23:05 +0000 Introduction. The aim of the present study was to determine the closeness of agreement between a self-reported and an objective measure of physical activity in low back pain patients and healthy controls. Beyond, influencing factors on overestimation were identified. Methods. 27 low back pain patients and 53 healthy controls wore an accelerometer (objective measure) for seven consecutive days and answered a questionnaire on physical activity (self-report) over the same period of time. Differences between self-reported and objective data were tested by Wilcoxon test. Bland-Altman analysis was conducted for describing the closeness of agreement. Linear regression models were calculated to identify the influence of age, sex, and body mass index on the overestimation by self-report. Results. Participants overestimated self-reported moderate activity in average by 42 min/day () and vigorous activity by 39 min/day (). Self-reported sedentary time was underestimated by 122 min/day (). No individual-related variables influenced the overestimation of physical activity. Low back pain patients were more likely to underestimate sedentary time compared to healthy controls. Discussion. In rehabilitation and health promotion, the application-oriented measurement of physical activity remains a challenge. The present results contradict other studies that had identified an influence of age, sex, and body mass index on the overestimation of physical activity. Andrea Schaller, Kevin Rudolf, Lea Dejonghe, Christopher Grieben, and Ingo Froboese Copyright © 2016 Andrea Schaller et al. All rights reserved. Synergistic Effects of Six Chronic Disease Pairs on Decreased Physical Activity: The SMILE Cohort Study Thu, 05 May 2016 12:07:08 +0000 Little is known about whether and how two chronic diseases interact with each other in modifying the risk of physical inactivity. The aim of the present study is to identify chronic disease pairs that are associated with compliance or noncompliance with the Dutch PA guideline recommendation and to study whether specific chronic disease pairs indicate an extra effect on top of the effects of the diseases individually. Cross-sectional data from 3,386 participants of cohort study SMILE were used and logistic regression analysis was performed to study the joint effect of the two diseases of each chronic disease pair for compliance with the Dutch PA guideline. For six chronic disease pairs, patients suffering from both diseases belonging to these disease pairs in question show a higher probability of noncompliance to the Dutch PA guideline, compared to what one would expect based on the effects of each of the two diseases alone. These six chronic disease pairs were chronic respiratory disease and severe back problems; migraine and inflammatory joint disease; chronic respiratory disease and severe kidney disease; chronic respiratory disease and inflammatory joint disease; inflammatory joint disease and rheumatoid arthritis; and rheumatoid arthritis and osteoarthritis of the knees, hips, and hands. Sarah Dörenkamp, Ilse Mesters, Rein Vos, Jan Schepers, Marjan van den Akker, Joep Teijink, and Rob de Bie Copyright © 2016 Sarah Dörenkamp et al. All rights reserved. A 12-Week Vigorous Exercise Protocol in a Healthy Group of Persons over 65: Study of Physical Function by means of the Senior Fitness Test Tue, 03 May 2016 15:46:46 +0000 The aim of this study was to assess the effects of vigorous exercise on functional abilities by means of a Senior Fitness Test (SFT) in a group of elderly adults. Twenty healthy and inactive people performed vigorous exercise (VE: 12 men and 8 women, aged 69.6 ± 3.9 years). At the beginning of the study (T0) and after 3 months (T1), each subject’s functional ability was tested for muscular strength, agility, cardiovascular fitness, flexibility, and balance. The VE was designed with continuous and interval exercise involving large muscle activities. Functional exercises were performed between 60% and 84% of heart rate reserve (HRR) for a duration of 65 minutes. Five out of the 6 SFTs performed were found significantly improved: Chair Stand (T0 12.4 ± 2.4, T1 13.5 ± 2.6, ), Arm Curl (T0 14.2 ± 3.6, T1 16.6 ± 3.6, ), 2 min step (T0 98.2 ± 15.7, T1 108.9 ± 16.2, ), Chair Sit-and-Reach (T0 −9.9 ± 7.7 cm, T1 1.7 ± 6.3 cm, ), and Back Scratch (T0 −15.8 ± 10.9 cm, T1 −8.4 ± 13.1 cm, ). Our results suggest that a high intensity protocol and functional exercises can improve functional mobility and muscle endurance in those over 65 years of age. SFTs are an effective method for assessing improvements in the functional capacity of elderly adults. Francesco Todde, Franco Melis, Roberto Mura, Massimiliano Pau, Francesco Fois, Sara Magnani, Gianfranco Ibba, Antonio Crisafulli, and Filippo Tocco Copyright © 2016 Francesco Todde et al. All rights reserved. Advances in Long Term Physical Behaviour Monitoring Mon, 11 Apr 2016 15:19:40 +0000 Jorunn L. Helbostad, Lorenzo Chiari, Sebastien Chastin, and Kamiar Aminian Copyright © 2016 Jorunn L. Helbostad et al. All rights reserved. Phenotypic Variation in Patients with Chronic Obstructive Pulmonary Disease in Primary Care Mon, 11 Apr 2016 08:19:46 +0000 Introduction. Despite the high number of inactive patients with COPD, not all inactive patients are referred to physical therapy, unlike recommendations of general practitioner (GP) guidelines. It is likely that GPs take other factors into account, determining a subpopulation that is treated by a physical therapist (PT). The aim of this study is to explore the phenotypic differences between inactive patients treated in GP practice and inactive patients treated in GP practice combined with PT. Additionally this study provides an overview of the phenotype of patients with COPD in PT practice. Methods. In a cross-sectional study, COPD patient characteristics were extracted from questionnaires. Differences regarding perceived health status, degree of airway obstruction, exacerbation frequency, and comorbidity were studied in a subgroup of 290 inactive patients and in all 438 patients. Results. Patients treated in GP practice combined with PT reported higher degree of airway obstruction, more exacerbations, more vascular comorbidity, and lower health status compared to patients who were not referred to and treated by a PT. Conclusion. Unequal patient phenotypes in different primary care settings have important clinical implications. It can be carefully concluded that other factors, besides the level of inactivity, play a role in referral to PT. Emmylou Beekman, Ilse Mesters, Mark G. Spigt, Eva A. M. van Eerd, Rik Gosselink, Rob A. de Bie, and Onno C. P. van Schayck Copyright © 2016 Emmylou Beekman et al. All rights reserved. Effects of Exercise Interventions and Physical Activity Behavior on Cancer Related Cognitive Impairments: A Systematic Review Sun, 10 Apr 2016 08:54:33 +0000 This systematic review analyzes current data on effects of exercise interventions and physical activity behavior on objective and subjective cancer related cognitive impairments (CRCI). Out of the 19 studies which met all inclusion criteria, five RCTs investigated rodents, whereas the other 14 trials explored humans and these included six RCTs, one controlled trial, two prospective noncontrolled trials, one case series, one observational study, and three cross-sectional studies. The results from animal models revealed positive effects of exercise during and after chemotherapy or radiation on structural alterations of the central nervous system, physiological as well as neuropsychological outcomes. The overall study quality in patient studies was poor. The current data on intervention studies showed preliminary positive effects of Asian-influenced movement programs (e.g., Yoga) with benefits on self-perceived cognitive functions as well as a reduction of chronic inflammation for breast cancer patients in the aftercare. Exercise potentially contributes to the prevention and rehabilitation of CRCI. Additional RCTs with standardized neuropsychological assessments and controlling for potential confounders are needed to confirm and expand preliminary findings. Philipp Zimmer, Freerk T. Baumann, Max Oberste, Peter Wright, Alexander Garthe, Alexander Schenk, Thomas Elter, Daniel A. Galvao, Wilhelm Bloch, Sven T. Hübner, and Florian Wolf Copyright © 2016 Philipp Zimmer et al. All rights reserved. Arm Crank and Wheelchair Ergometry Produce Similar Peak Oxygen Uptake but Different Work Economy Values in Individuals with Spinal Cord Injury Sun, 10 Apr 2016 07:32:32 +0000 Objective. To study whether values for peak oxygen uptake () and work economy (WE) at a standardized workload are different when tested by arm crank ergometry (ACE) and wheelchair ergometry (WCE). Methods. Twelve paraplegic men with spinal cord injury (SCI) in stable neurological condition participated in this cross-sectional repeated-measures study. We determined and peak power output () values during ACE and WCE in a work-matched protocol. Work economy was tested at a standardized workload of 30 Watts (W) for both ACE and WCE. Results. There were no significant differences in (mL·kg−1·min−1) between ACE () and WCE () trials, and a Bland-Altman plot shows that findings are within 95% level of agreement. WE or oxygen consumption at 30 W () was significantly lower during WCE compared to ACE (). Mean (95% CI) (W) were 130 (111–138) and 100 (83–110) during ACE and WCE, respectively. Conclusion. The findings in the present study support the use of both ACE and WCE for testing peak oxygen uptake. However, WE differed between the two test modalities, meaning that less total energy is used to perform external work of 30 W during wheelchair exercise when using this WCE (VP100 Handisport ergometer). Clinical Trials Protocol Record is NCT00987155/4.2007.2271. Tom Tørhaug, Berit Brurok, Jan Hoff, Jan Helgerud, and Gunnar Leivseth Copyright © 2016 Tom Tørhaug et al. All rights reserved. tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke Thu, 31 Mar 2016 09:09:58 +0000 Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT) on stroke survivors. Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week) over two weeks. Outcome measures were collected before and after treatment: (i) Fugl-Meyer Assessment-Upper Extremity (FMA-UE), (ii) Box and Block Test (BBT), and (iii) Motor Activity Log (MAL). Results. Both groups reported a significant improvement in FMA-UE score after treatment (). No significant between-groups differences were found in motor function. However, when the analysis was adjusted for stroke type and duration, a significant interaction effect () was detected, showing that stroke duration (acute versus chronic) and type (cortical versus subcortical) modify the effect of tDCS and robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes. Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies. Sofia Straudi, Felipe Fregni, Carlotta Martinuzzi, Claudia Pavarelli, Stefano Salvioli, and Nino Basaglia Copyright © 2016 Sofia Straudi et al. All rights reserved. The Hip Functional Retrieval after Elective Surgery May Be Enhanced by Supplemented Essential Amino Acids Thu, 24 Mar 2016 13:20:56 +0000 It is not known whether postsurgery systemic inflammation and plasma amino acid abnormalities are still present during rehabilitation of individuals after elective hip arthroplasty (EHA). Sixty subjects (36 females; age years) were randomized to receive 14-day oral EAAs (8 g/day) or a placebo (maltodextrin). At admission to and discharge from the rehabilitation center, serum C-reactive protein (CRP) and venous plasma amino acid concentrations were determined. Post-EHA hip function was evaluated by Harris hip score (HHS) test. Ten matched healthy subjects served as controls. At baseline, all patients had high CRP levels, considerable reduction in several amino acids, and severely reduced hip function (HHS scores). After treatment, inflammation decreased both in the EAA group and in the placebo group. Only EAA patients significantly improved their levels of glycine, alanine, tyrosine, and total amino acids. In addition, they enhanced the rate of hip function recovery (HHS) (from baseline to versus baseline to in placebo one; ). The study documents the persistence of inflammation and plasma amino acid abnormalities in post-EHA rehabilitation phase. EAAs enhance hip function retrieval and improve plasma amino acid abnormalities. Eleonora Baldissarro, Roberto Aquilani, Federica Boschi, Paola Baiardi, Paolo Iadarola, Marco Fumagalli, Evasio Pasini, Manuela Verri, Maurizia Dossena, Arianna Gambino, Sharon Cammisuli, and Simona Viglio Copyright © 2016 Eleonora Baldissarro et al. All rights reserved. Retrieval of Individual Participant Data for Exercise Meta-Analyses May Not Be Worth the Time and Effort Tue, 08 Mar 2016 09:45:01 +0000 Purpose. While individual participant data (IPD) meta-analyses are considered the gold standard for meta-analysis, the feasibility of obtaining IPD may be problematic. Methods. Using data from a previous meta-analysis of 29 studies on exercise in adults with arthritis and other rheumatic diseases, the percentage of studies in which useable IPD was provided was calculated. Results. Eight of 29 authors (28%, 95% CI = 11% to 44%) provided IPD. Using logistic regression, neither year of publication (odds ratio = 1.05, 95% CI = 0.90 to 1.27, ) nor country (odds ratio = 1.36, 95% CI = 0.20 to 10.9, ) was significantly associated with the obtainment of IPD. Conclusions. The retrieval of IPD for exercise meta-analyses may not be worth the time and effort. However, further research is needed before any final recommendations can be made. George A. Kelley and Kristi S. Kelley Copyright © 2016 George A. Kelley and Kristi S. Kelley. All rights reserved. A Virtual Reality-Cycling Training System for Lower Limb Balance Improvement Sun, 06 Mar 2016 13:09:04 +0000 Stroke survivors might lose their walking and balancing abilities, but many studies pointed out that cycling is an effective means for lower limb rehabilitation. However, during cycle training, the unaffected limb tends to compensate for the affected one, which resulted in suboptimal rehabilitation. To address this issue, we present a Virtual Reality-Cycling Training System (VRCTS), which senses the cycling force and speed in real-time, analyzes the acquired data to produce feedback to patients with a controllable VR car in a VR rehabilitation program, and thus specifically trains the affected side. The aim of the study was to verify the functionality of the VRCTS and to verify the results from the ten stroke patients participants and to compare the result of Asymmetry Ratio Index (ARI) between the experimental group and the control group, after their training, by using the bilateral pedal force and force plate to determine any training effect. The results showed that after the VRCTS training in bilateral pedal force it had improved by 0.22 () and in force plate the stand balance has also improved by 0.29 (); thus both methods show the significant difference. Chieh Yin, Ya-Hsin Hsueh, Chun-Yu Yeh, Hsin-Chang Lo, and Yi-Ting Lan Copyright © 2016 Chieh Yin et al. All rights reserved. Analysis of Trunk Rolling Performances by Mattress Mobility Detection System in Poststroke Patients: A Pilot Study Thu, 03 Mar 2016 08:02:08 +0000 Purpose. The purpose of this study was to investigate the correlation of kinematic variables with quality of trunk control in poststroke patients. Methods. This cross-sectional study included stroke subjects with mild to moderate motor deficit corresponding to Brunnstrom stages 3-4. Trunk functional performance was measured using bed mobility monitor system. All tasks were repeated ten times for both directions in each subject. Outcome measurements included the movement time and displacement of center of pressure (CoP) from supine to side lying and returning. Results. The results revealed that a significant longer turning time was observed when turning from the paretic side toward the nonparetic side compared to the other direction, with an estimated mean difference of 0.427 sec (). We found a significant difference in the time of rolling back to supine position between two directions. The displacement of CoP in rolling back from side lying on the nonparetic side was smaller than that from the paretic side with an estimated mean difference of −0.797 cm (). Conclusions. The impaired trunk mobility was associated with increased movement time and decreased displacement of CoP in poststroke patients. Trunk rolling performance has potential in assessment of stroke patients. Shang-Lin Chiang, Chia-Huei Lin, Chueh-Ho Lin, Liang-Hsuan Lu, Shin-Tsu Chang, Wen-Hsu Sung, and Shun-Hwa Wei Copyright © 2016 Shang-Lin Chiang et al. All rights reserved. Does the Length of Elbow Flexors and Visual Feedback Have Effect on Accuracy of Isometric Muscle Contraction in Men after Stroke? Wed, 02 Mar 2016 13:30:28 +0000 The aim of the study was to determine the effect of different muscle length and visual feedback information (VFI) on accuracy of isometric contraction of elbow flexors in men after an ischemic stroke (IS). Materials and Methods. Maximum voluntary muscle contraction force (MVMCF) and accurate determinate muscle force (20% of MVMCF) developed during an isometric contraction of elbow flexors in 90° and 60° of elbow flexion were measured by an isokinetic dynamometer in healthy subjects (MH, ) and subjects after an IS during their postrehabilitation period (MS, ). Results. In order to evaluate the accuracy of the isometric contraction of the elbow flexors absolute errors were calculated. The absolute errors provided information about the difference between determinate and achieved muscle force. Conclusions. There is a tendency that greater absolute errors generating determinate force are made by MH and MS subjects in case of a greater elbow flexors length despite presence of VFI. Absolute errors also increase in both groups in case of a greater elbow flexors length without VFI. MS subjects make greater absolute errors generating determinate force without VFI in comparison with MH in shorter elbow flexors length. Vilma Juodzbaliene, Tomas Darbutas, Albertas Skurvydas, and Marius Brazaitis Copyright © 2016 Vilma Juodzbaliene et al. All rights reserved. Mobility in Old Age: Capacity Is Not Performance Mon, 29 Feb 2016 16:53:33 +0000 Background. Outcomes of laboratory-based tests for mobility are often used to infer about older adults’ performance in real life; however, it is unclear whether such association exists. We hypothesized that mobility capacity, as measured in the laboratory, and mobility performance, as measured in real life, would be poorly linked. Methods. The sample consisted of 84 older adults ( years). Capacity was assessed via the iTUG and standard gait parameters (stride length, stride velocity, and cadence). Performance was assessed in real life over a period of days using smartphone technology to calculate following parameters: active and gait time, number of steps, life-space, mean action-range, and maximum action-range. Correlation analyses and stepwise multiple regression analyses were applied. Results. All laboratory measures demonstrated significant associations with the real-life measures (between and ). The multiple regression analyses indicated that the laboratory measures accounted for a significant but very low proportion of variance (between 5% and 21%) in real-life measures. Conclusion. In older adults without mobility impairments, capacity-related measures of mobility bear little significance for predicting real-life performance. Hence, other factors play a role in how older people manage their daily-life mobility. This should be considered for diagnosis and treatment of mobility deficits in older people. Eleftheria Giannouli, Otmar Bock, Sabato Mellone, and Wiebren Zijlstra Copyright © 2016 Eleftheria Giannouli et al. All rights reserved. Effect of Motivation by “Instagram” on Adherence to Physical Activity among Female College Students Mon, 29 Feb 2016 07:26:06 +0000 Objective. To investigate the efficacy of using “Instagram application” with a “home-exercise program” as a motivational stimulus in improving physical activity (PA) adherence levels among female college students. Methods. Fifty-eight female undergraduate students with the mean age years participated. Participants were divided into two groups: intervention and the control group; both the groups received an exercise program and the intervention group was additionally motivated by “Instagram.” Adherence to PA was measured by using an adherence sheet. The Exercise Motivation Inventory (EMI-2) was used to assess the motivational factors. Results. The most frequent motivational factors were extrinsic as assessed using the EMI-2. “Positive health” was the most frequent factor mentioned of the two types with 47% of the sample. The intervention group adhered with 17% more to the activity program compared to the control group. Moreover, 72% of the participants in the intervention and control groups found the activity program flexible enough to be performed at home; they agreed about its effectiveness on adherence (53%). Conclusions. The use of Instagram with the home exercise program as a motivational modality could be attractive and effective to reinforce adherence and maintain an appropriate PA level. Einas Al-Eisa, Asma Al-Rushud, Ahmad Alghadir, Shahnawaz Anwer, Bashayer Al-Harbi, Noha Al-Sughaier, Noha Al-Yoseef, Reem Al-Otaibi, and Hanadi Ali Al-Muhaysin Copyright © 2016 Einas Al-Eisa et al. All rights reserved. The Effect of Two Different Cognitive Tests on Gait Parameters during Dual Tasks in Healthy Postmenopausal Women Sun, 28 Feb 2016 08:23:24 +0000 Introduction. The paper aims to evaluate the influence of two different demanding cognitive tasks on gait parameters using BTS SMART system analysis. Patients and Methods. The study comprised 53 postmenopausal women aged 64.5 ± 6.7 years (range: 47–79). For every subject, gait analysis using a BTS SMART system was performed in a dual-task study design under three conditions: (I) while walking only (single task), (II) walking while performing a simultaneous simple cognitive task (SCT) (dual task), and (III) walking while performing a simultaneous complex cognitive task (CCT) (dual task). Time-space parameters of gait pertaining to the length of a single support phase, double support phase, gait speed, step length, step width, and leg swing speed were analyzed. Results. Performance of cognitive tests during gait resulted in a statistically significant prolongation of the left (by 7%) and right (by 7%) foot gait cycle, shortening of the length of steps made with the right extremity (by 4%), reduction of speed of swings made with the left (by 11%) and right (by 8%) extremity, and reduction in gait speed (by 6%). Conclusions. Performance of cognitive tests during gait changes its individual pattern in relation to the level of the difficulty of the task. Magdalena Hagner-Derengowska, Krystian Kałużny, Wojciech Hagner, Anna Kałużna, Bartosz Kochański, Alina Borkowska, and Jacek Budzyński Copyright © 2016 Magdalena Hagner-Derengowska et al. All rights reserved. Effects of 4-Week Intensive Active-Resistive Training with an EMG-Based Exoskeleton Robot on Muscle Strength in Older People: A Pilot Study Tue, 23 Feb 2016 12:27:38 +0000 This study aims to investigate the idea that an active-resistive training with an EMG-based exoskeleton robot could be beneficial to muscle strength and antagonist muscle cocontraction control after 4-week intensive elbow flexion/extension training. Three older people over 65 years participated the training for an hour per session and completed total 20 sessions during four weeks. Outcome measures were chosen as the maximum joint torque and cocontraction ratio between the biceps/triceps brachii muscles at pre-/post-training. The Wilcoxon signed-ranks test was performed to evaluate paired difference for the outcome measures. As a result, there was no significant difference in the maximum flexion or extension torque at pre- and post-training. However, the cocontraction ratio of the triceps brachii muscle as the antagonist was significantly decreased by 9.8% after the 4-week intensive training. The active-resistive training with the exoskeleton robot in the older people yielded a promising result, showing significant changes in the antagonist muscle cocontraction. Jongsang Son, Jeseong Ryu, Soonjae Ahn, Eun Joo Kim, Jung Ah Lee, and Youngho Kim Copyright © 2016 Jongsang Son et al. All rights reserved. Could In-Home Sensors Surpass Human Observation of People with Parkinson’s at High Risk of Falling? An Ethnographic Study Sun, 14 Feb 2016 08:54:03 +0000 Self-report underpins our understanding of falls among people with Parkinson’s (PwP) as they largely happen unwitnessed at home. In this qualitative study, we used an ethnographic approach to investigate which in-home sensors, in which locations, could gather useful data about fall risk. Over six weeks, we observed five independently mobile PwP at high risk of falling, at home. We made field notes about falls (prior events and concerns) and recorded movement with video, Kinect, and wearable sensors. The three women and two men (aged 71 to 79 years) having moderate or severe Parkinson’s were dependent on others and highly sedentary. We most commonly noted balance protection, loss, and restoration during chair transfers, walks across open spaces and through gaps, turns, steps up and down, and tasks in standing (all evident walking between chair and stairs, e.g.). Our unobtrusive sensors were acceptable to participants: they could detect instability during everyday activity at home and potentially guide intervention. Monitoring the route between chair and stairs is likely to give information without invading the privacy of people at high risk of falling, with very limited mobility, who spend most of the day in their sitting rooms. Emma Stack, Rachel King, Balazs Janko, Malcolm Burnett, Nicola Hammersley, Veena Agarwal, Sion Hannuna, Alison Burrows, and Ann Ashburn Copyright © 2016 Emma Stack et al. All rights reserved. Role of the Frontal Cortex in Standing Postural Sway Tasks While Dual-Tasking: A Functional Near-Infrared Spectroscopy Study Examining Working Memory Capacity Wed, 03 Feb 2016 07:30:56 +0000 Posture control during a dual-task involves changing the distribution of attention resources between the cognitive and motor tasks and involves the frontal cortex working memory (WM). The present study aimed to better understand the impact of frontal lobe activity and WM capacity in postural control during a dual-task. High and low WM-span groups were compared using their reading span test scores. High and low WM capacity were compared based on cognitive and balance performance and hemoglobin oxygenation (oxyHb) levels during standing during single (S-S), standing during dual (S-D), one leg standing during single (O-S), and one leg standing during dual (O-D) tasks. For sway pass length, significant difference in only the O-D task was observed between both groups. oxyHb levels were markedly increased in the right dorsolateral prefrontal cortex and supplementary motor area in the high-span group during a dual-task. Therefore, WM capacity influenced the allocation of attentional resources and motor performance. Hiroyuki Fujita, Kenji Kasubuchi, Satoshi Wakata, Makoto Hiyamizu, and Shu Morioka Copyright © 2016 Hiroyuki Fujita et al. All rights reserved. Behavioral Periodicity Detection from 24 h Wrist Accelerometry and Associations with Cardiometabolic Risk and Health-Related Quality of Life Sun, 31 Jan 2016 13:34:57 +0000 Periodicities (repeating patterns) are observed in many human behaviors. Their strength may capture untapped patterns that incorporate sleep, sedentary, and active behaviors into a single metric indicative of better health. We present a framework to detect periodicities from longitudinal wrist-worn accelerometry data. GENEActiv accelerometer data were collected from 20 participants (17 men, 3 women, aged 35–65) continuously for (range: 13.9 to 102.0) consecutive days. Cardiometabolic risk biomarkers and health-related quality of life metrics were assessed at baseline. Periodograms were constructed to determine patterns emergent from the accelerometer data. Periodicity strength was calculated using circular autocorrelations for time-lagged windows. The most notable periodicity was at 24 h, indicating a circadian rest-activity cycle; however, its strength varied significantly across participants. Periodicity strength was most consistently associated with LDL-cholesterol (’s = 0.40–0.79, ’s < 0.05) and triglycerides (’s = 0.68–0.86, ’s < 0.05) but also associated with hs-CRP and health-related quality of life, even after adjusting for demographics and self-rated physical activity and insomnia symptoms. Our framework demonstrates a new method for characterizing behavior patterns longitudinally which captures relationships between 24 h accelerometry data and health outcomes. Matthew P. Buman, Feiyan Hu, Eamonn Newman, Alan F. Smeaton, and Dana R. Epstein Copyright © 2016 Matthew P. Buman et al. All rights reserved. Use of a Remote Eye-Tracker for the Analysis of Gaze during Treadmill Walking and Visual Stimuli Exposition Tue, 19 Jan 2016 13:44:03 +0000 The knowledge of the visual strategies adopted while walking in cognitively engaging environments is extremely valuable. Analyzing gaze when a treadmill and a virtual reality environment are used as motor rehabilitation tools is therefore critical. Being completely unobtrusive, remote eye-trackers are the most appropriate way to measure the point of gaze. Still, the point of gaze measurements are affected by experimental conditions such as head range of motion and visual stimuli. This study assesses the usability limits and measurement reliability of a remote eye-tracker during treadmill walking while visual stimuli are projected. During treadmill walking, the head remained within the remote eye-tracker workspace. Generally, the quality of the point of gaze measurements declined as the distance from the remote eye-tracker increased and data loss occurred for large gaze angles. The stimulus location (a dot-target) did not influence the point of gaze accuracy, precision, and trackability during both standing and walking. Similar results were obtained when the dot-target was replaced by a static or moving 2D target and “region of interest” analysis was applied. These findings foster the feasibility of the use of a remote eye-tracker for the analysis of gaze during treadmill walking in virtual reality environments. V. Serchi, A. Peruzzi, A. Cereatti, and U. Della Croce Copyright © 2016 V. Serchi et al. All rights reserved. Effectiveness of the Virtual Reality System Toyra on Upper Limb Function in People with Tetraplegia: A Pilot Randomized Clinical Trial Mon, 18 Jan 2016 07:37:51 +0000 The aim of this study was to investigate the effects of a virtual reality program combined with conventional therapy in upper limb function in people with tetraplegia and to provide data about patients’ satisfaction with the virtual reality system. Thirty-one people with subacute complete cervical tetraplegia participated in the study. Experimental group received 15 sessions with Toyra® virtual reality system for 5 weeks, 30 minutes/day, 3 days/week in addition to conventional therapy, while control group only received conventional therapy. All patients were assessed at baseline, after intervention, and at three-month follow-up with a battery of clinical, functional, and satisfaction scales. Control group showed significant improvements in the manual muscle test ( = 0,043, partial = 0,22) in the follow-up evaluation. Both groups demonstrated clinical, but nonsignificant, changes to their arm function in 4 of the 5 scales used. All patients showed a high level of satisfaction with the virtual reality system. This study showed that virtual reality added to conventional therapy produces similar results in upper limb function compared to only conventional therapy. Moreover, the gaming aspects incorporated in conventional rehabilitation appear to produce high motivation during execution of the assigned tasks. This trial is registered with EudraCT number 2015-002157-35. I. Dimbwadyo-Terrer, A. Gil-Agudo, A. Segura-Fragoso, A. de los Reyes-Guzmán, F. Trincado-Alonso, S. Piazza, and B. Polonio-López Copyright © 2016 I. Dimbwadyo-Terrer et al. All rights reserved. High Intensity Resistance Training Methods with and without Protein Supplementation to Fight Cardiometabolic Risk in Middle-Aged Males: A Randomized Controlled Trial Mon, 18 Jan 2016 07:37:47 +0000 Time-effective protocols may potentially increase people’s compliance with exercise. The purpose of this paper was to compare the relative effects of 16 weeks of high intensity (resistance) training (HIT) with and without protein supplementation (HIT&P) and HVHIT (high volume/high intensity training) versus a nontraining control group on cardiometabolic risk factors. One hundred and twenty untrained males 30–50 years old were randomly assigned to 3 subgroups: (a) a HIT group; (b) a HIT&P group, and (c) a waiting-control group (phase I) that crossed over to (d) high volume/high intensity training (HVHIT) during the second study phase. HIT was defined as “single set to failure protocol” while HVHIT consistently applied two sets. Protein supplementation provided an overall intake of 1.5 g/kg/body mass. Primary study endpoint was the metabolic syndrome -Score (MetS--Score). MetS--Score significantly improved in all exercise groups () with no significant difference between HIT, HIT&P, and HVHIT (). However, all the exercise groups differed significantly from the CG () which deteriorated significantly (). In conclusion, all exercise protocols were similarly effective in improving cardiometabolic risk factors. Thus, HIT may be the best choice for people with low time budgets looking to improve their cardiometabolic health. Wolfgang Kemmler, Andreas Wittke, Michael Bebenek, Michael Fröhlich, and Simon von Stengel Copyright © 2016 Wolfgang Kemmler et al. All rights reserved. Predicting Functional Recovery in Chronic Stroke Rehabilitation Using Event-Related Desynchronization-Synchronization during Robot-Assisted Movement Sun, 17 Jan 2016 13:21:22 +0000 Although rehabilitation robotics seems to be a promising therapy in the rehabilitation of the upper limb in stroke patients, consensus is still lacking on its additive effects. Therefore, there is a need for determining the possible success of robotic interventions on selected patients, which in turn determine the necessity for new investigating instruments supporting the treatment decision-making process and customization. The objective of the work presented in this preliminary study was to verify that fully robot assistance would not affect the physiological oscillatory cortical activity related to a functional movement in healthy subjects. Further, the clinical results following the robotic treatment of a chronic stroke patient, who positively reacted to the robotic intervention, were analyzed and discussed. First results show that there is no difference in EEG activation pattern between assisted and no-assisted movement in healthy subjects. Even more importantly, the patient’s pretreatment EEG activation pattern in no-assisted movement was completely altered, while it recovered to a quasi-physiological one in robot-assisted movement. The functional improvement following treatment was large. Using pretreatment EEG recording during robot-assisted movement might be a valid approach to assess the potential ability of the patient for recovering. Marco Caimmi, Elisa Visani, Fabio Digiacomo, Alessandro Scano, Andrea Chiavenna, Cristina Gramigna, Lorenzo Molinari Tosatti, Silvana Franceschetti, Franco Molteni, and Ferruccio Panzica Copyright © 2016 Marco Caimmi et al. All rights reserved. Kinesio Taping Does Not Alter Quadriceps Isokinetic Strength and Power in Healthy Nonathletic Men: A Prospective Crossover Study Thu, 24 Dec 2015 12:35:32 +0000 Objectives. The effects of Kinesio Taping (KT) on muscular performance remain largely unclear. This study aimed to investigate the acute effects of KT on the maximum concentric and eccentric quadriceps isokinetic strength. Study Design. This is a single-blinded, placebo crossover, repeated measures study. Methods. Maximum isokinetic concentric/eccentric extension torque, work, and power were assessed by an isokinetic dynamometer without taping (NT) and with KT or placebo taping (PT) in 17 healthy young men. Repeated measures one-way analysis of variance (ANOVA) was used for statistical analyses. Results. Testing concentric contractions at 60°/s or 180°/s isokinetic speed, no significant differences in peak torque (Nm), total work (J), or mean power (W) were noted among the application modes under different conditions. Testing eccentric contractions at 30°/s or 60°/s isokinetic speed, no significant differences in mentioned parameters were noted, respectively. KT on the quadriceps neither decreased nor increased muscle strength in the participants. Conclusion. KT application onto the skin overlying the quadriceps muscle does not enhance the strength or power of knee extensors in healthy men. Paweł Korman, Anna Straburzyńska-Lupa, Radosław Rutkowski, Jakub Gruszczyński, Jacek Lewandowski, Marcin Straburzyński-Lupa, and Dawid Łochyński Copyright © 2015 Paweł Korman et al. All rights reserved. Quantification of Outdoor Mobility by Use of Accelerometer-Measured Physical Behaviour Mon, 07 Dec 2015 11:29:41 +0000 Hip fractures in older persons are associated with both low levels of daily physical activity and loss of outdoor mobility. The aim was to investigate if accelerometer-based measures of physical behaviour can be used to determine if people undertake outdoor walking and to provide reference values for physical behaviour outcomes related to outdoor mobility. Older persons (), ≥70 years, one year after hip fracture, participated. Six objective measures of physical behaviour collected by an activity monitor were compared with self-reported outdoor mobility assessed with the Nottingham Extended ADL scale. All measures of time and length in upright periods were significantly lower in participants who reported not walking outdoors (). A set of cut-off points for the different physical behaviour variables was generated. Maximum length of upright events discriminated best between groups, with 31 minutes as a threshold to determine if a person is more likely to report that they walk outdoors (sensitivity: 0.805, specificity: 0.704, and AUC: 0.871) or 41 minutes or more to determine if a person is more likely to report outdoor walking on their own (AUC: 0.891). Physical behaviour variables from activity monitoring can provide information about patterns of physical behaviour related to outdoor activity performance. Kristin Taraldsen, Malcolm H. Granat, and Jorunn L. Helbostad Copyright © 2015 Kristin Taraldsen et al. All rights reserved. Rehabilitation and Improvement of the Postural Function Thu, 12 Nov 2015 11:47:24 +0000 Thierry Paillard, Massimiliano Pau, Frédéric Noé, and Luis-Millán González Copyright © 2015 Thierry Paillard et al. All rights reserved. Techniques and Methods for Testing the Postural Function in Healthy and Pathological Subjects Thu, 12 Nov 2015 09:08:15 +0000 The different techniques and methods employed as well as the different quantitative and qualitative variables measured in order to objectify postural control are often chosen without taking into account the population studied, the objective of the postural test, and the environmental conditions. For these reasons, the aim of this review was to present and justify the different testing techniques and methods with their different quantitative and qualitative variables to make it possible to precisely evaluate each sensory, central, and motor component of the postural function according to the experiment protocol under consideration. The main practical and technological methods and techniques used in evaluating postural control were explained and justified according to the experimental protocol defined. The main postural conditions (postural stance, visual condition, balance condition, and test duration) were also analyzed. Moreover, the mechanistic exploration of the postural function often requires implementing disturbing postural conditions by using motor disturbance (mechanical disturbance), sensory stimulation (sensory manipulation), and/or cognitive disturbance (cognitive task associated with maintaining postural balance) protocols. Each type of disturbance was tackled in order to facilitate understanding of subtle postural control mechanisms and the means to explore them. Thierry Paillard and Frédéric Noé Copyright © 2015 Thierry Paillard and Frédéric Noé. All rights reserved. Changes of Plantar Pressure and Gait Parameters in Children with Mild Cerebral Palsy Who Used a Customized External Strap Orthosis: A Crossover Study Tue, 10 Nov 2015 06:05:15 +0000 Toe-in gait and crouch gait can make children with mild cerebral palsy fall and suffer improper balance during walking or ambulation training. A customized external strap orthosis for correcting leg alignment was used to resolve this problem. The purpose of this study was to research the immediate effects while wearing the customized external strap orthosis. Pressure platform was used to assess the plantar pressure through static and dynamic assessments and to record the changes in path of pressure trajectory. Motion image analysis system was used to record the gait parameters, which included gait speed, stride length, and cadence. The influence of both wearing and removing the orthosis on the dominant leg of children with mild cerebral palsy was analyzed. Nine children with mild cerebral palsy, who all had a dominant right leg, were recruited. After wearing the orthosis, all gait parameters improved, and foot motion changed in the stance phase of the gait cycle. The path of pressure trajectory closing to the midline was also observed during dynamic assessment. Changes in plantar pressure and path of pressure trajectory were observed and the orthosis device could provide immediate assistance to correct the leg alignment and improve the gait performance in children with mild cerebral palsy. Wen-Dien Chang, Nai-Jen Chang, Hung-Yu Lin, and Ping-Tung Lai Copyright © 2015 Wen-Dien Chang et al. All rights reserved. Evaluation of Myoelectric Activity of Paraspinal Muscles in Adolescents with Idiopathic Scoliosis during Habitual Standing and Sitting Sun, 25 Oct 2015 11:35:36 +0000 There is a number of research work in the literature that have applied sEMG biofeedback as an instrument for muscle rehabilitation. Therefore, sEMG is a good tool for this research work and is used to record the myoelectric activity in the paraspinal muscles of those with AIS during habitual standing and sitting. After the sEMG evaluation, the root-mean-square (RMS) sEMG values of the paraspinal muscles in the habitual postures reflect the spinal curvature situation of the PUMC Type Ia and IIc subjects. Both groups have a stronger average RMS sEMG value on the convex side of the affected muscle regions. Correction to posture as instructed by the physiotherapist has helped the subjects to achieve a more balanced RMS sEMG ratio in the trapezius and latissimus dorsi regions; the erector spinae in the thoracic region and/or erector spinae in the lumbar region. It is, therefore, considered that with regular practice of the suggested positions, those with AIS can use motor learning to achieve a more balanced posture. Consequently, the findings can be used in less intrusive early orthotic intervention and provision of care to those with AIS. Garcia Kwok, Joanne Yip, Mei-Chun Cheung, and Kit-Lun Yick Copyright © 2015 Garcia Kwok et al. All rights reserved. Effects of Fourteen-Day Bed Rest on Trunk Stabilizing Functions in Aging Adults Sun, 25 Oct 2015 11:34:46 +0000 Bed rest has been shown to have detrimental effects on structural and functional characteristics of the trunk muscles, possibly affecting trunk and spinal stability. This is especially important in populations such as aging adults with often altered trunk stabilizing functions. This study examined the effects of a fourteen-day bed rest on anticipatory postural adjustments and postural reflex responses of the abdominal wall and back muscles in sixteen adult men. Postural activation of trunk muscles was measured using voluntary quick arm movement and sudden arm loading paradigm. Measurements were conducted prior to the bed rest, immediately after, and fourteen days after the bed rest. Immediately after the bed rest, latencies of anticipatory postural adjustments showed significant shortening, especially for the obliquus internus and externus muscles. After a fourteen-day recuperation period, anticipatory postural adjustments reached a near to complete recovery. On the contrary, reactive response latencies increased from pre-bed-rest to both post-bed-rest measurement sessions. Results indicate an important effect of bed rest on stabilizing functions of the trunk muscles in elderly adults. Moreover, there proved to be a significant deterioration of postural reactive responses that outlasted the 14-day post-bed-rest rehabilitation. Nejc Sarabon and Jernej Rosker Copyright © 2015 Nejc Sarabon and Jernej Rosker. All rights reserved. The Impact of a Vestibular-Stimulating Exercise Regime on Postural Stability in People with Visual Impairment Sun, 25 Oct 2015 11:33:38 +0000 The aim of the study was to assess the impact of a vestibular-stimulating exercise regime on postural stability in individuals with visual impairment. The study group consisted of 70 people, including 28 persons (15 female and 13 male) with visual impairment and 42 (21 female and 21 male) without visual impairment. Each individual in the group with visual impairment was medically qualified for a 3-month training program. The research methodology included medical examination, anthropometric tests, and stabilometry tests on a Biodex Balance System SD (BBS). The tests were conducted twice: once before the start of training and again after 3 months of rehabilitation. The group with visual impairment showed significantly worse postural stability results than the control group for most of the stability parameters evaluated (OSI, APSI, and MLSI). Differences were noted between the groups with and without visual impairment for dynamic tests in women and for static tests in men. After training, the two groups showed roughly similar results for the stabilometry test with eyes closed. We conclude that exercises stimulating the vestibular system with head and body movements should be recommended for individuals with visual impairments to achieve better balance retention. Ida Wiszomirska, Katarzyna Kaczmarczyk, Michalina Błażkiewicz, and Andrzej Wit Copyright © 2015 Ida Wiszomirska et al. All rights reserved. Effectiveness and Limitations of Unsupervised Home-Based Balance Rehabilitation with Nintendo Wii in People with Multiple Sclerosis Sun, 25 Oct 2015 11:33:22 +0000 Balance training represents a critical part of the rehabilitation process of individuals living with multiple sclerosis (MS) since impaired postural control is a distinctive symptom of the disease. In recent years, the use of the Nintendo Wii system has become widespread among rehabilitation specialists for this purpose, but few studies have verified the effectiveness of such an approach using quantitative measures of balance. In this study, we analyzed the postural sway features of a cohort of twenty-seven individuals with MS before and after 5 weeks of unsupervised home-based balance training with the Wii system. Center of pressure (COP) time-series were recorded using a pressure platform and processed to calculate sway area, COP path length, displacements, and velocities in mediolateral (ML) and anteroposterior (AP) directions. Although the results show a significant reduction in sway area, COP displacements, and velocity, such improvements are essentially restricted to the ML direction, as the Wii platform appears to properly stimulate the postural control system in the frontal plane but not in the sagittal one. Available Wii games, although somewhat beneficial, appear not fully suitable for rehabilitation in MS owing to scarce flexibility and adaptability to MS needs and thus specific software should be developed. Massimiliano Pau, Giancarlo Coghe, Federica Corona, Bruno Leban, Maria Giovanna Marrosu, and Eleonora Cocco Copyright © 2015 Massimiliano Pau et al. All rights reserved. Crossover versus Stabilometric Platform for the Treatment of Balance Dysfunction in Parkinson’s Disease: A Randomized Study Sun, 25 Oct 2015 11:29:34 +0000 Balance dysfunctions are a major challenge in the treatment of Parkinson’s disease (PD). Previous studies have shown that rehabilitation can play a role in their treatment. In this study, we have compared the efficacy of two different devices for balance training: stabilometric platform and crossover. We have enrolled 60 PD patients randomly assigned to two groups. The first one (stabilometric group) performed a 4-week cycle of balance training, using the stabilometric platform, whereas the second one (crossover group) performed a 4-week cycle of balance training, using the crossover. The outcome measures used were Unified Parkinson’s Disease Rating Scale (UPDRS) part II, Berg Balance Scale (BBS), Timed Up and Go (TUG), and Six Minutes Walking Test (6MWT). Results showed that TUG, BBS, and UPDRS II improved in both groups. There was not difference in the efficacy of the two balance treatments. Patients in both groups improved also the meters walked in the 6MWT at the end of rehabilitation, but the improvement was better for patients performing crossover training. Our results show that the crossover and the stabilometric platform have the same effect on balance dysfunction of Parkinsonian patients, while crossover gets better results on the walking capacity. G. Frazzitta, F. Bossio, R. Maestri, G. Palamara, R. Bera, and D. Ferrazzoli Copyright © 2015 G. Frazzitta et al. All rights reserved. Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss Sun, 25 Oct 2015 11:07:41 +0000 Many studies were interested in the consequence of vestibular dysfunction related to cochlear implantation on balance control. This pilot study aimed to assess the effects of unilateral cochlear implantation on the modalities of balance control and sensorimotor strategies. Posturographic and vestibular evaluations were performed in 10 patients (55 ± 20 years) with profound hearing loss who were candidates to undergo unilateral multichannel cochlear implantation. The evaluation was carried out shortly before and one year after surgery. Posturographic tests were also performed in 10 age-matched healthy participants (63 ± 16 years). Vestibular compensation was observed within one year. In addition, postural performances of the patients increased within one year after cochlear implantation, especially in the more complex situations, in which sensory information is either unavailable or conflicting. Before surgery, postural performances were higher in the control group compared to the patients’ group. One year after cochlear implantation, postural control was close to normalize. The improvement of postural performance could be explained by a mechanism of vestibular compensation. In addition, the recovery of auditory information which is the consequence of cochlear implantation could lead to an extended exploration of the environment possibly favoring the development of new balance strategies. Cécile Parietti-Winkler, Alexis Lion, Bettina Montaut-Verient, Rémy Grosjean, and Gérome C. Gauchard Copyright © 2015 Cécile Parietti-Winkler et al. All rights reserved. Recovery of Posture Stability at Different Foot Placements in Patients Who Underwent Minimally Invasive Total Hip Arthroplasty: A One-Year Follow-Up Study Sun, 25 Oct 2015 09:43:53 +0000 To understand the progression of recovery in postural stability and physical functioning after patients received the minimally invasive total hip arthroplasty (MTHA), we monitor the pain level, functional capacity, and postural stability before and after operation within one year. In total of 23 subjects in our study, we found out that MTHA was effective in relieving pain in first 2 weeks and restoring the hip joint integrity, but the postural stability was influenced especially in tandem stand in both anterior-posterior and medial-lateral directions. The recovery of postural stability and functional capacity in one year duration fluctuated and no consistent improvement tendency was found. We suggested clinicians designing postsurgery rehabilitation program for consistent and progressive long-term recovery of postural stability and fall prevention to optimize surgical results and prevent undesired postoperative consequences. Chun-Ju Chang, Na-Ling Lin, Mel S. Lee, and Jen-Suh Chern Copyright © 2015 Chun-Ju Chang et al. All rights reserved. Mobility and Balance and Their Correlation with Physiological Factors in Elderly with Different Foot Postures Sun, 25 Oct 2015 09:33:40 +0000 This study determines (1) the correlation between mobility and balance performances with physiological factors and (2) the relationship between foot postures with anthropometric characteristics and lower limb characteristics among elderly with neutral, pronated, and supinated foot. A cross-sectional observational study was conducted in community-dwelling elderly (age: 69.86 ± 5.62 years). Participants were grouped into neutral (), pronated (), and supinated () foot based on the foot posture index classification. Anthropometric data (height, weight, and BMI), lower limb strength (5-STS) and endurance (30 s chair rise test), mobility (TUG), and balance (FSST) were determined. Data were analyzed using Spearman’s correlation coefficient. Body weight was negatively and moderately correlated (, ) with mobility in supinated foot; moderate-to-high positive linear rank correlation was found between lower limb strength and mobility ( to 0.804, ) for pronated and neutral foot. Lower limb endurance was negatively and linearly correlated with mobility in pronated () and neutral () foot. No correlation was observed in balance performance with physiological factors in any of the foot postures. We can conclude that muscle function may be the most important feature to make movement possible in older persons regardless of the type of foot postures. Aisyah Mohd Said, Haidzir Manaf, Saiful Adli Bukry, and Maria Justine Copyright © 2015 Aisyah Mohd Said et al. All rights reserved. The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury Sun, 25 Oct 2015 09:24:12 +0000 Balance control improvement is one of the most important goals in sports and exercise. Better balance is strongly positively associated with enhanced athletic performance and negatively associated with lower limb sports injuries. Proprioception plays an essential role in balance control, and ankle proprioception is arguably the most important. This paper reviews ankle proprioception and explores synergies with balance control, specifically in a sporting context. Central processing of ankle proprioceptive information, along with other sensory information, enables integration for balance control. When assessing ankle proprioception, the most generalizable findings arise from methods that are ecologically valid, allow proprioceptive signals to be integrated with general vision in the central nervous system, and reflect the signal-in-noise nature of central processing. Ankle proprioceptive intervention concepts driven by such a central processing theory are further proposed and discussed for the improvement of balance control in sport. Jia Han, Judith Anson, Gordon Waddington, Roger Adams, and Yu Liu Copyright © 2015 Jia Han et al. All rights reserved. Effect of Workplace- versus Home-Based Physical Exercise on Muscle Response to Sudden Trunk Perturbation among Healthcare Workers: A Cluster Randomized Controlled Trial Sun, 25 Oct 2015 09:02:55 +0000 Objectives. The present study investigates the effect of workplace- versus home-based physical exercise on muscle reflex response to sudden trunk perturbation among healthcare workers. Methods. Two hundred female healthcare workers (age: 42 [SD 11], BMI: 24 [SD 4], and pain intensity: 3.1 [SD 2.2] on a scale of 0–10) from 18 departments at three hospitals were randomized at the cluster level to 10 weeks of (1) workplace physical exercise (WORK) performed in groups during working hours for 5 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (2) home-based physical exercise (HOME) performed during leisure time for 5 10 minutes per week. Mechanical and neuromuscular (EMG) response to randomly assigned unloading and loading trunk perturbations and questions of fear avoidance were assessed at baseline and 10-week follow-up. Results. No group by time interaction for the mechanical trunk response and EMG latency time was seen following the ten weeks ( = 0.17–0.75). However, both groups demonstrated within-group changes () in stopping time during the loading and unloading perturbation and in stopping distance during the loading perturbation. Furthermore, EMG preactivation of the erector spinae and fear avoidance were reduced more following WORK than HOME (95% CI −2.7–−0.7 () and −0.14 (−0.30 to 0.02) ()), respectively. WORK and HOME performed 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions per week, respectively. Conclusions. Although training adherence was higher following WORK compared to HOME this additional training volume did not lead to significant between-group differences in the responses to sudden trunk perturbations. However, WORK led to reduced fear avoidance and reduced muscle preactivity prior to the perturbation onset, compared with HOME. This trial is registered with (NCT01921764). Markus D. Jakobsen, Emil Sundstrup, Mikkel Brandt, Kenneth Jay, Per Aagaard, and Lars L. Andersen Copyright © 2015 Markus D. Jakobsen et al. All rights reserved. Mobile Phone-Based Joint Angle Measurement for Functional Assessment and Rehabilitation of Proprioception Sun, 25 Oct 2015 08:55:13 +0000 Assessment of joint functional and proprioceptive abilities is essential for balance, posture, and motor control rehabilitation. Joint functional ability refers to the capacity of movement of the joint. It may be evaluated thereby measuring the joint range of motion (ROM). Proprioception can be defined as the perception of the position and of the movement of various body parts in space. Its role is essential in sensorimotor control for movement acuity, joint stability, coordination, and balance. Its clinical evaluation is commonly based on the assessment of the joint position sense (JPS). Both ROM and JPS measurements require estimating angles through goniometer, scoliometer, laser-pointer, and bubble or digital inclinometer. With the arrival of Smartphones, these costly clinical tools tend to be replaced. Beyond evaluation, maintaining and/or improving joint functional and proprioceptive abilities by training with physical therapy is important for long-term management. This review aims to report Smartphone applications used for measuring and improving functional and proprioceptive abilities. It identifies that Smartphone applications are reliable for clinical measurements and are mainly used to assess ROM and JPS. However, there is lack of studies on Smartphone applications which can be used in an autonomous way to provide physical therapy exercises at home. Quentin Mourcou, Anthony Fleury, Bruno Diot, Céline Franco, and Nicolas Vuillerme Copyright © 2015 Quentin Mourcou et al. All rights reserved. Correlation between Trunk Posture and Neck Reposition Sense among Subjects with Forward Head Neck Postures Sun, 25 Oct 2015 08:29:56 +0000 Objective. To assess the correlation of abnormal trunk postures and reposition sense of subjects with forward head neck posture (FHP). Methods. In all, postures of 41 subjects were evaluated and the FHP and trunk posture including shoulder, scapular level, pelvic side, and anterior tilting degrees were analyzed. We used the head repositioning accuracy (HRA) test to evaluate neck position senses of neck flexion, neck extension, neck right and left side flexion, and neck right and left rotation and calculated the root mean square error in trials for each subject. Spearman’s rank correlation coefficients and regression analysis were used to assess the degree of correlation between the trunk posture and HRA value, and a significance level of α = 0.05 was considered. Results. There were significant correlations between the HRA value of right side neck flexion and pelvic side tilt angle . If pelvic side tilting angle increases by 1 degree, right side neck flexion increased by 0.76 degrees . However, there were no significant correlations between other neck motions and trunk postures. Conclusion. Verifying pelvic postures should be prioritized when movement is limited due to the vitiation of the proprioceptive sense of neck caused by FHP. Han Suk Lee, Hyung Kuk Chung, and Sun Wook Park Copyright © 2015 Han Suk Lee et al. All rights reserved. Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis Sun, 25 Oct 2015 08:25:58 +0000 Objectives. This systematic review was conducted to examine the effects of exercise on spinal deformities and quality of life in patients with adolescent idiopathic scoliosis (AIS). Data Sources. Electronic databases, including PubMed, CINAHL, Embase, Scopus, Cochrane Register of Controlled Trials, PEDro, and Web of Science, were searched for research articles published from the earliest available dates up to May 31, 2015, using the key words “exercise,” “postural correction,” “posture,” “postural curve,” “Cobb’s angle,” “quality of life,” and “spinal deformities,” combined with the Medical Subject Heading “scoliosis.” Study Selection. This systematic review was restricted to randomized and nonrandomized controlled trials on AIS published in English language. The quality of selected studies was assessed by the PEDro scale, the Cochrane Collaboration’s tool, and the Grading of Recommendations Assessment, Development, and Evaluation System (GRADE). Data Extraction. Descriptive data were collected from each study. The outcome measures of interest were Cobb angle, trunk rotation, thoracic kyphosis, lumbar kyphosis, vertebral rotation, and quality of life. Data Synthesis. A total of 30 studies were assessed for eligibility. Six of the 9 selected studies reached high methodological quality on the PEDro scale. Meta-analysis revealed moderate-quality evidence that exercise interventions reduce the Cobb angle, angle of trunk rotation, thoracic kyphosis, and lumbar lordosis and low-quality evidence that exercise interventions reduce average lateral deviation. Meta-analysis revealed moderate-quality evidence that exercise interventions improve the quality of life. Conclusions. A supervised exercise program was superior to controls in reducing spinal deformities and improving the quality of life in patients with AIS. Shahnawaz Anwer, Ahmad Alghadir, Md. Abu Shaphe, and Dilshad Anwar Copyright © 2015 Shahnawaz Anwer et al. All rights reserved. Relationships of Balance, Gait Performance, and Functional Outcome in Chronic Stroke Patients: A Comparison of Left and Right Lesions Sun, 25 Oct 2015 08:24:00 +0000 Introduction. This study compared the balance by center of pressure (COP) and its relationship with gait parameters and functional independence in left (LH) and right (RH) chronic stroke patients. Methods. In this cross-sectional study, twenty-one hemiparetic stroke patients were assessed for Functional Independence Measure (FIM), balance with a force platform, and gait in the Motion Analysis Laboratory. Results. The amplitudes of the COP in the anteroposterior and mediolateral directions were similar in both groups. The anteroposterior direction was greater than the mediolateral direction. Only the temporal parameters showed any statistically significant differences. The LH showed a significant correlation between stride length, step length, and gait velocity with COP velocity sway for the healthy and paretic lower limbs. In both groups, the area of COP was significantly correlated with stride length. Motor FIM was significantly correlated with the COP in the LH group. Conclusion. There was no difference in the performance of balance, gait, and functional independence between groups. The correlation of the COP sway area with stride length in both groups can serve as a guideline in the rehabilitation of these patients where training the static balance may reflect the improvement of the stride length. Priscila Garcia Lopes, José Augusto Fernandes Lopes, Christina Moran Brito, Fábio Marcon Alfieri, and Linamara Rizzo Battistella Copyright © 2015 Priscila Garcia Lopes et al. All rights reserved. Effects of Whole-Body Cryotherapy in Comparison with Other Physical Modalities Used with Kinesitherapy in Rheumatoid Arthritis Wed, 21 Oct 2015 12:59:39 +0000 Whole-body cryotherapy (WBC) has been frequently used to supplement the rehabilitation of patients with rheumatoid arthritis (RA). The aim of this study was to compare the effect of WBC and traditional rehabilitation (TR) on clinical parameters and systemic levels of IL-6, TNF-α in patients with RA. The study group comprised 25 patients who were subjected to WBC (−110°C) and 19 patients who underwent a traditional rehabilitation program. Some clinical variables and levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were used to assess the outcomes. After therapy both groups exhibited similar improvement in pain, disease activity, fatigue, time of walking, and the number of steps over a distance of 50 m. Only significantly better results were observed in HAQ in TR group (p < 0.05). However, similar significant reduction in IL-6 and TNF-α level was observed. The results showed positive effects of a 2-week rehabilitation program for patients with RA regardless of the kind of the applied physical procedure. Małgorzata Gizińska, Radosław Rutkowski, Wojciech Romanowski, Jacek Lewandowski, and Anna Straburzyńska-Lupa Copyright © 2015 Małgorzata Gizińska et al. All rights reserved. Long-Term Monitoring of Physical Behavior Reveals Different Cardiac Responses to Physical Activity among Subjects with and without Chronic Neck Pain Sun, 18 Oct 2015 12:24:49 +0000 Background. We determined the extent to which heart rate variability (HRV) responses to daily physical activity differ between subjects with and without chronic neck pain. Method. Twenty-nine subjects (13 women) with chronic neck pain and 27 age- and gender-matched healthy controls participated. Physical activity (accelerometry), HRV (heart rate monitor), and spatial location (Global Positioning System (GPS)) were recorded for 74 hours. GPS data were combined with a diary to identify periods of work and of leisure at home and elsewhere. Time- and frequency-domain HRV indices were calculated and stratified by period and activity type (lying/sitting, standing, or walking). ANCOVAs with multiple adjustments were used to disclose possible group differences in HRV. Results. The pain group showed a reduced HRV response to physical activity compared with controls (), according to the sympathetic-baroreceptor HRV index (LF/HF, ratio between low- and high-frequency power), even after adjustment for leisure time physical activity, work stress, sleep quality, mental health, and aerobic capacity (). The parasympathetic response to physical activity did not differ between groups. Conclusions. Relying on long-term monitoring of physical behavior and heart rate variability, we found an aberrant sympathetic-baroreceptor response to daily physical activity among subjects with chronic neck pain. David M. Hallman, Svend Erik Mathiassen, and Eugene Lyskov Copyright © 2015 David M. Hallman et al. All rights reserved. Patient Preferences for Receiving Remote Communication Support for Lifestyle Physical Activity Behaviour Change: The Perspective of Patients with Musculoskeletal Disorders from Three Hospital Services Wed, 30 Sep 2015 14:34:28 +0000 This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods. People with musculoskeletal disorders ( of 296 eligible) accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”). Results. Most (, 70%) desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10), followed by email and telephone (both 5/10), text messaging (1/10), and private Internet-based social network messages (0/10). Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, ), telephone calls (coefficient = 3.000, ), and email (coefficient = 2.059, ). Older age was associated with lower preference for email (coefficient = −0.100, ), texting (coefficient = −0.096, ), and social network messages (coefficient = −0.065, ). Conclusion. Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls. Steven M. McPhail, Mandy Schippers, Carol A. Maher, and Alison L. Marshall Copyright © 2015 Steven M. McPhail et al. All rights reserved. The Discriminant Value of Phase-Dependent Local Dynamic Stability of Daily Life Walking in Older Adult Community-Dwelling Fallers and Nonfallers Wed, 30 Sep 2015 09:01:34 +0000 The present study compares phase-dependent measures of local dynamic stability of daily life walking with 35 conventional gait features in their ability to discriminate between community-dwelling older fallers and nonfallers. The study reanalyzes 3D-acceleration data of 3-day daily life activity from 39 older people who reported less than 2 falls during one year and 31 who reported two or more falls. Phase-dependent local dynamic stability was defined for initial perturbation at 0%, 20%, 40%, 60%, and 80% of the step cycle. A partial least square discriminant analysis (PLS-DA) was used to compare the discriminant abilities of phase-dependent local dynamic stability with the discriminant abilities of 35 conventional gait features. The phase-dependent local dynamic stability λ at 0% and 60% of the step cycle discriminated well between fallers and nonfallers (AUC = 0.83) and was significantly larger () for the nonfallers. Furthermore, phase-dependent λ discriminated as well between fallers and nonfallers as all other gait features combined. The present result suggests that phase-dependent measures of local dynamic stability of daily life walking might be of importance for further development in early fall risk screening tools. Espen A. F. Ihlen, Aner Weiss, Jorunn L. Helbostad, and Jeffrey M. Hausdorff Copyright © 2015 Espen A. F. Ihlen et al. All rights reserved. Influence of the Weight of a School Backpack on Spinal Curvature in the Sagittal Plane of Seven-Year-Old Children Thu, 27 Aug 2015 06:55:07 +0000 The aim of the paper was to determine a correlation between the weight of a child’s backpack, their body weight, and certain features of their body posture. Material and Methods. The study group consisted of 109 children, all aged seven years. The parameters of body posture were determined using the Zebris Ultrasonic System. Results. The number of children carrying a school backpack in accordance with recommendations was 44 subjects (40.37%). Statistically significant changes were found in the total length of the spine (, ) and between backpack weight and changes in the following parameters: the total length of the spine (, ), the length and the angle of the lumbar lordosis (, ), the angle of the lumbar lordosis (, ), and the sacral angle (, ). Conclusions. Wearing a backpack heavier than 10% of one’s body weight can cause shallowing of the lumbar lordosis and a tendency towards a vertical position of the sacrum. Monitoring the weight of children’s school backpacks and enabling them to leave books and notebooks at school would probably be beneficial in reducing the daily burden put on children’s spines. Katarzyna Walicka-Cupryś, Renata Skalska-Izdebska, Maciej Rachwał, and Aleksandra Truszczyńska Copyright © 2015 Katarzyna Walicka-Cupryś et al. All rights reserved. New Technologies for the Management and Rehabilitation of Chronic Diseases and Conditions Wed, 24 Jun 2015 06:16:51 +0000 Gianluca Castelnuovo, Giancarlo Mauri, Susan Simpson, Angela Colantonio, and Stephen Goss Copyright © 2015 Gianluca Castelnuovo et al. All rights reserved. Skin Resistivity Value of Upper Trapezius Latent Trigger Points Sun, 21 Jun 2015 07:59:06 +0000 Introduction. The skin resistivity (SkR) measurement is commonly recommended for acupoints measurement, but for trigger points (TrPs) only one study is available. The purpose of the study was to evaluate SkR for latent TrPs compared to non-TrPs and the surrounding tissue. Material and Methods. Forty-two healthy volunteers with unilateral latent upper trapezius TrPs (12 men, 30 women) aged 21–23 (mean age: 22.1 ± 0.6 y) participated in the study. Keithley electrometer 610B was used for measuring SkR (Ag/AgCl self-adhesive, disposable ground electrode: 30 mm diameter). SkR was measured for latent TrPs and compared to opposite non-TrPs sites and the surrounding tissue. Results. The SkR decrease of TrPs-positive sites as compared to TrPs-negative sites and the surrounding tissue was confirmed. However, no statistically significant difference in the SkR value occurred when all data were analyzed. The same was confirmed after gender division and for TrPs-positive subjects examined for referred pain and twitch response presence. Conclusion. SkR reactive changes at latent TrPs are possible but the results were not consistent with the previous study. Thus, caution in applying SkR to latent TrPs isolation is recommended and its clinical use should not be encouraged yet. Further studies, especially on active TrPs, are yet required. Elżbieta Skorupska, Jarosław Zawadziński, Agata Bednarek, and Włodzimierz Samborski Copyright © 2015 Elżbieta Skorupska et al. All rights reserved. Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials Wed, 17 Jun 2015 07:26:20 +0000 Objective. Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. Design. A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. Results. Nine studies were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (; 95% CI: −0.37 to −0.09; ). These effects were also significant in patients undergoing chemotherapy . Nonsignificant differences were found for resistance training interventions . Slight evidence of publication bias was observed . The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)). Conclusion. Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments. José Francisco Meneses-Echávez, Emilio González-Jiménez, and Robinson Ramírez-Vélez Copyright © 2015 José Francisco Meneses-Echávez et al. All rights reserved. A Portable Gait Asymmetry Rehabilitation System for Individuals with Stroke Using a Vibrotactile Feedback Tue, 16 Jun 2015 10:32:44 +0000 Gait asymmetry caused by hemiparesis results in reduced gait efficiency and reduced activity levels. In this paper, a portable rehabilitation device is proposed that can serve as a tool in diagnosing gait abnormalities in individuals with stroke and has the capability of providing vibration feedback to help compensate for the asymmetric gait. Force-sensitive resistor (FSR) based insoles are used to detect ground contact and estimate stance time. A controller (Arduino) provides different vibration feedback based on the gait phase measurement. It also allows wireless interaction with a personal computer (PC) workstation using the XBee transceiver module, featuring data logging capabilities for subsequent analysis. Walking trials conducted with healthy young subjects allowed us to observe that the system can influence abnormality in the gait. The results of trials showed that a vibration cue based on temporal information was more effective than intensity information. With clinical experiments conducted for individuals with stroke, significant improvement in gait symmetry was observed with minimal disturbance caused to the balance and gait speed as an effect of the biofeedback. Future studies of the long-term rehabilitation effects of the proposed system and further improvements to the system will result in an inexpensive, easy-to-use, and effective rehabilitation device. Muhammad Raheel Afzal, Min-Kyun Oh, Chang-Hee Lee, Young Sook Park, and Jungwon Yoon Copyright © 2015 Muhammad Raheel Afzal et al. All rights reserved. The Effects of Aquatic Exercises on Physical Fitness and Muscle Function in Dialysis Patients Tue, 16 Jun 2015 09:35:02 +0000 Purpose. The aim of this study was to assess the impact of a 3-month physical training program, conducted in an aquatic environment with end-stage renal disease patients (ESRD), on the physical fitness and functional parameters of the knee joint muscles. Patients and Methods. The study included 20 ESDR patients with mean age  y. treated with hemodialysis in Dialysis Center of the University Hospital in Wroclaw. Before and 3 months after the physical training in water, a test was performed to evaluate the physical fitness of each patient; additionally, a measurement was taken of force-velocity parameters. The 3-month training program took place on nonhemodialysis days, in the recreational pool of the University of Physical Education in Wroclaw. Results. After aquatic training cycle, an improvement was observed in all parameters measured using the Fullerton test. The value of peak torque and its relation to body mass increased in the movement of flexors and extensors of left and right lower extremities in all tested velocities. Conclusions. In assessing the physical fitness of studied women, the biggest improvement was achieved in tests assessing the strength of upper and lower extremities as well as lower body flexibility. Higher values of force-velocity parameters are conducive to women achieving better physical fitness test results. Wioletta Dziubek, Katarzyna Bulińska, Łukasz Rogowski, Tomasz Gołębiowski, Mariusz Kusztal, Monika Grochola, Dominika Markowska, Agnieszka Zembroń-Łacny, Wacław Weyde, Marian Klinger, and Marek Woźniewski Copyright © 2015 Wioletta Dziubek et al. All rights reserved. The Effect of Park and Urban Environments on Coronary Artery Disease Patients: A Randomized Trial Tue, 16 Jun 2015 08:58:02 +0000 Aim. To test the hypothesis that walking in a park has a greater positive effect on coronary artery disease (CAD) patients’ hemodynamic parameters than walking in an urban environment. Methods. Twenty stable CAD patients were randomized into two groups: 30-minute walk on 7 consecutive days in either a city park or busy urban street. Wilcoxon signed-rank test was employed to study short-term (30 min) and cumulative changes (following 7 consecutive days of exposure) in resting hemodynamic parameters in different environments. Results. There were no statistically significant differences in the baseline and peak exercise systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), exercise duration, or HR recovery in urban versus park exposure groups. Seven days of walking slightly improved all hemodynamic parameters in both groups. Compared to baseline, the city park group exhibited statistically significantly greater reductions in HR and DBP and increases in exercise duration and HR recovery. The SBP and DBP changes in the urban exposed group were lower than in the park exposed group. Conclusions. Walking in a park had a greater positive effect on CAD patients’ cardiac function than walking in an urban environment, suggesting that rehabilitation through walking in green environments after coronary events should be encouraged. Regina Grazuleviciene, Jone Vencloviene, Raimondas Kubilius, Vytautas Grizas, Audrius Dedele, Tomas Grazulevicius, Indre Ceponiene, Egle Tamuleviciute-Prasciene, Mark J. Nieuwenhuijsen, Marc Jones, and Christopher Gidlow Copyright © 2015 Regina Grazuleviciene et al. All rights reserved. Co-Designing Ambient Assisted Living (AAL) Environments: Unravelling the Situated Context of Informal Dementia Care Tue, 16 Jun 2015 07:43:10 +0000 Ambient assisted living (AAL) aims to help older persons “age-in-place” and manage everyday activities using intelligent and pervasive computing technology. AAL research, however, has yet to explore how AAL might support or collaborate with informal care partners (ICPs), such as relatives and friends, who play important roles in the lives and care of persons with dementia (PwDs). In a multiphase codesign process with six (6) ICPs, we envisioned how AAL could be situated to complement their care. We used our codesigned “caregiver interface” artefacts as triggers to facilitate envisioning of AAL support and unpack the situated, idiosyncratic context within which AAL aims to assist. Our findings suggest that AAL should be designed to support ICPs in fashioning “do-it-yourself” solutions that complement tacitly improvised care strategies and enable them to try, observe, and adapt to solutions over time. In this way, an ICP could decide which activities to entrust to AAL support, when (i.e., scheduled or spontaneous) and how a system should provide support (i.e., using personalized prompts based on care experience), and when adaptations to system support are needed (i.e., based alerting patterns and queried reports). Future longitudinal work employing participatory, design-oriented methods with care dyads is encouraged. Amy S. Hwang, Khai N. Truong, Jill I. Cameron, Eva Lindqvist, Louise Nygård, and Alex Mihailidis Copyright © 2015 Amy S. Hwang et al. All rights reserved. A Bidimensional System of Facial Movement Analysis Conception and Reliability in Adults Tue, 16 Jun 2015 07:28:16 +0000 Objective. To design a bidimensional facial movement measuring tool and study its reliability. Methods. We utilized the free video-analysis software Kinovea that can track preselected points during movements and measure two-point distances off-line. Three raters positioned facial markers on 10 healthy individuals and video-taped them during maximal bilateral contractions of frontalis, corrugator, orbicularis oculi, zygomaticus, orbicularis oris, and buccinator, on two occasions. Each rater also analyzed the first video twice, one week apart. For each muscle, intrarater reliability was measured by percent agreements (PA) and intraclass correlation coefficients (ICC) between two assessments of the same video one week apart and between assessments of two videos collected one week apart. Interrater reliability was measured by PA, ICC, and coefficients of variation (CV) between assessments of the first video-recording by the three raters. Results. Intrarater and interrater reliabilities were good to excellent for frontalis (PA and ICC > 70%; CV < 15%), moderate for orbicularis oculi, zygomaticus, and orbicularis oris, and poor for corrugator and buccinators. Discussion. Without formal prior training, the proposed method was reliable for frontalis in healthy subjects. Improved marker selection, training sessions, and testing reliability in patients with facial paresis may enhance reliability for orbicularis oculi, zygomaticus, and orbicularis oris. Marjolaine Baude, Emilie Hutin, and Jean-Michel Gracies Copyright © 2015 Marjolaine Baude et al. All rights reserved. Validation and Test-Retest Reliability of New Thermographic Technique Called Thermovision Technique of Dry Needling for Gluteus Minimus Trigger Points in Sciatica Subjects and TrPs-Negative Healthy Volunteers Sun, 07 Jun 2015 15:49:19 +0000 The aim of this study was to assess the validity and test-retest reliability of Thermovision Technique of Dry Needling (TTDN) for the gluteus minimus muscle. TTDN is a new thermography approach used to support trigger points (TrPs) diagnostic criteria by presence of short-term vasomotor reactions occurring in the area where TrPs refer pain. Method. Thirty chronic sciatica patients ( TrP-positive and TrPs-negative) and 15 healthy volunteers were evaluated by TTDN three times during two consecutive days based on TrPs of the gluteus minimus muscle confirmed additionally by referred pain presence. TTDN employs average temperature (), maximum temperature (), low/high isothermal-area, and autonomic referred pain phenomenon (AURP) that reflects vasodilatation/vasoconstriction. Validity and test-retest reliability were assessed concurrently. Results. Two components of TTDN validity and reliability, and AURP, had almost perfect agreement according to (e.g., thigh: 0.880 and 0.938; calf: 0.902 and 0.956, resp.). The sensitivity for , , AURP, and high isothermal-area was 100% for everyone, but specificity of 100% was for and AURP only. Conclusion. TTDN is a valid and reliable method for and AURP measurement to support TrPs diagnostic criteria for the gluteus minimus muscle when digitally evoked referred pain pattern is present. Elżbieta Skorupska, Michał Rychlik, and Włodzimierz Samborski Copyright © 2015 Elżbieta Skorupska et al. All rights reserved. Can Early Rehabilitation after Total Hip Arthroplasty Reduce Its Major Complications and Medical Expenses? Report from a Nationally Representative Cohort Thu, 04 Jun 2015 11:29:38 +0000 Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA) complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab) and delayed rehabilitation (Delayed Rehab). Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all ) higher medical and rehabilitation expenses and more outpatient department (OPD) visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR): 3.152; 95% confidence interval (CI): 1.211–8.203; ) than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA. Daniel Chiung-Jui Su, Kuo-Shu Yuan, Shih-Feng Weng, Rong-Bin Hong, Ming-Ping Wu, Hing-Man Wu, and Willy Chou Copyright © 2015 Daniel Chiung-Jui Su et al. All rights reserved. Swimming Activity Prevents the Unloading Induced Loss of Bone Mass, Architecture, and Strength in Rats Mon, 18 May 2015 11:43:33 +0000 We investigated whether swimming activity associated with a three-week period of hypoactivity could prevent the deleterious effects of disuse on the tibias of tail-suspended rats. Forty Wistar rats were divided into five groups: (HS) permanently hindlimb suspension rats; (HS + Swim) rats submitted to unloading interrupted by swimming exercise; (HS + WB) hindlimb suspension rats with interruption for regular weight bearing for the same length of time as the HS+Swim rats; (Control) control rats that were allowed regular cage activities; and (Control + Swim) control rats that underwent swimming exercise. At the end of the experiment, bone mineral density, bone strength, and trabecular quantification were analyzed. The hindlimb-suspended rats exhibited bone quality loss (significant decrease in BMD, bone strength, and deterioration of trabecular and cortical bone architecture; decrease in BV/TV, TbN, TbTh, ConnD, CtV, and CtTh; and increase in TbSp) when compared to control rats. In contrast, trained rats showed a significant increase of 43% in bone mass, 29% in bone strength, 58% in trabecular thickness, 85% in bone volume, 27% in trabeculae number, and 30% in cortical volume, when compared to the hindlimb-suspended rats. We conclude that swimming activity not only ameliorates but also fully prevents the deleterious effects on bone quality in osteopenic rats. Maurício J. Falcai, Ariane Zamarioli, Graziela Bianchi Leoni, Manoel Damião de Sousa Neto, and Jose B. Volpon Copyright © 2015 Maurício J. Falcai et al. All rights reserved. Correlation between the Quality of Attention and Cognitive Competence with Motor Action in Stroke Patients Sun, 19 Apr 2015 11:51:29 +0000 It is considered that cognitive function and attention could affect walking, motion control, and proper conduct during the walk. To determine whether there is a difference in the quality of attention and cognitive ability in stroke patients and patients without neurological damage of similar age and education and to determine whether the connection of attention and cognition affects motor skills, the sample consisted of 50 stroke patients tested with hemiparesis, involved in the process of rehabilitation, and 50 persons, randomly chosen, without neurological damage. The survey used the following tests: Trail Making (TMT A B) test for assessing the flexibility of attention; Mini-Mental State Examination (MMSE) for cognitive status; Functional Ambulation Category (FAC) test to assess the functional status and parameters of walk: speed, frequency, and length of stride; STEP test for assessing the precision of movement and balance. With stroke patients, relationship between age and performance on the MMSE test was marginally significant. The ratio of performance to TMT A B test and years does not indicate statistical significance, while statistical significance between the MMSE test performance and education exists. In stroke patients, performance on MMSE test is correlated with the frequency and length of stride walk. The quality of cognitive function and attention is associated with motor skills but differs in stroke patients and people without neurological damage of similar age. The significance of this correlation can supplement research in neurorehabilitation, improve the quality of medical rehabilitation, and contribute to efficient recovery of these patients. S. Arsic, Lj. Konstantinovic, F. Eminovic, D. Pavlovic, M. B. Popovic, and V. Arsic Copyright © 2015 S. Arsic et al. All rights reserved. Building a Framework for a Dual Task Taxonomy Sun, 19 Apr 2015 06:48:01 +0000 The study of dual task interference has gained increasing attention in the literature for the past 35 years, with six MEDLINE citations in 1979 growing to 351 citations indexed in 2014 and a peak of 454 cited papers in 2013. Increasingly, researchers are examining dual task cost in individuals with pathology, including those with neurodegenerative diseases. While the influence of these papers has extended from the laboratory to the clinic, the field has evolved without clear definitions of commonly used terms and with extreme variations in experimental procedures. As a result, it is difficult to examine the interference literature as a single body of work. In this paper we present a new taxonomy for classifying cognitive-motor and motor-motor interference within the study of dual task behaviors that connects traditional concepts of learning and principles of motor control with current issues of multitasking analysis. As a first step in the process we provide an operational definition of dual task, distinguishing it from a complex single task. We present this new taxonomy, inclusive of both cognitive and motor modalities, as a working model; one that we hope will generate discussion and create a framework from which one can view previous studies and develop questions of interest. Tara L. McIsaac, Eric M. Lamberg, and Lisa M. Muratori Copyright © 2015 Tara L. McIsaac et al. All rights reserved. Wheeled Mobility Wed, 01 Apr 2015 14:09:24 +0000 Alicia M. Koontz, Dan Ding, Yih-Kuen Jan, Sonja de Groot, and Andrew Hansen Copyright © 2015 Alicia M. Koontz et al. All rights reserved. Relationship between Cognitive Performance and Motor Dysfunction in Patients with Parkinson’s Disease: A Pilot Cross-Sectional Study Tue, 31 Mar 2015 12:01:16 +0000 The aim of this pilot cross-sectional study was to extensively investigate the relationships between cognitive performance and motor dysfunction involving balance and gait ability in patients with Parkinson’s disease. Twenty subjects with Parkinson’s disease underwent a cognitive (outcomes: Frontal Assessment Battery-Italian version, Montreal overall Cognitive Assessment, Trail Making Test, Semantic Verbal Fluency Test, and Memory with Interference Test) and motor (outcomes: Berg Balance Scale, 10-Meter Walking Test, 6-Minute Walking Test, Timed Up and Go Test performed also under dual task condition, and Unified Parkinson’s Disease Rating Scale) assessment. Our correlation analyses showed that balance skills are significantly correlated with executive functions, cognitive impairment, and ability to switch attention between two tasks. Furthermore, functional mobility showed a significant correlation with cognitive impairment, verbal fluency, and ability to switch attention between two tasks. In addition, the functional mobility evaluated under the dual task condition showed a significant correlation with cognitive impairment and ability to switch attention between two tasks. These findings might help early identification of cognitive deficits or motor dysfunctions in patients with Parkinson’s disease who may benefit from rehabilitative strategies. Future prospective larger-scale studies are needed to strengthen our results. Valentina Varalta, Alessandro Picelli, Cristina Fonte, Stefania Amato, Camilla Melotti, Vanja Zatezalo, Leopold Saltuari, and Nicola Smania Copyright © 2015 Valentina Varalta et al. 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.