A. Crippa

Concepts of Motor Learning Applied to a Rehabilitation Protocol Using Biofeedback to Improve Gait in a Chronic Stroke Patient: An A-B System Study With Multiple Gait Analyses

Objective. The impact of electromyographic biofeedback (EMG BFB) applied during functional gait activities and employed in accord with theories on motor learning was investigated in a chronic hemiplegic patient. Methods. A single-subject A-B design was used. EMG BFB was applied to the triceps surae during gait. A rehabilitation program with a fading frequency of BFB application and an increasing variability in the task training was implemented. Responses to the rehabilitation program were documented via multiple quantitative gait analyses, performed during a baseline, treatment, and at follow-up 6 weeks after the end of treatment. Results.From baseline to end of treatment, there were significant changes in ankle power at push-off, both in amplitude and timing, as well as onset of ankle power at push-off relative to heel strike of the healthy leg. There was a significant increase in gait velocity, step length of the healthy side, stride length, and stride frequency. At follow-up, changes were still significantly different from baseline and the patient had reduced the use of the cane in activities of daily living. Conclusions. BFB appears to have been effective in promoting positive changes in gait in this pilot study. The rehabilitation protocol also appeared to be effective in promoting learning and the incorporation of trained activities into daily activities.

Are Modular Activations Altered in Lower Limb Muscles of Persons with Multiple Sclerosis during Walking? Evidence from Muscle Synergies and Biomechanical Analysis

Background: Persons with Multiple Sclerosis frequently have gait deficits that lead to diminished activities of daily living. Identification of motoneuron activity patterns may elucidate new insight into impaired locomotor coordination and underlying neural systems. The aim of the present study was to investigate muscle synergies, identified by motor modules and their activation profiles, in persons with Multiple Sclerosis (PwMS) during walking compared to those of healthy subjects (HS), as well as, exploring relationship of muscle synergies with walking ability of PwMS. Methods: Seventeen PwMS walked at their natural speed while 12 HS walked at slower than their natural speeds in order to provide normative gait values at matched speeds (spatio-temporal, kinematic, and kinetic parameters and electromyography signals). Non-negative matrix factorization was used to identify muscle synergies from eight muscles. Pearsons correlation coefficient was used to evaluate the similarity of motor modules between PwMS and HS. To assess differences in module activations, each modules activation timing was integrated over 100% of gait cycle and the activation percentage was computed in six phases. Results: Fifty-nine% of PwMS and 58% of HS had 4 modules while the remaining of both populations had 3 modules. Module 2 (related to soleus, medial, and lateral gastrocnemius primarily involved in mid and terminal stance) and Module 3 (related to tibialis anterior and rectus femoris primarily involved in early stance, and early and late swing) were comparable across all subjects regardless of synergies number. PwMS had shorter stride length, longer double support phase and push off deficit with respect to HS (p < 0.05). The alterations of activation timing profiles of specific modules in PwMS were associated with their walking deficits (e.g., the reduction of Module 2 activation percentage index in terminal stance, PwMS 35.55 ± 13.23 vs. HS 50.51 ± 9.13% p < 0.05, and the push off deficit, PwMS 0.181 ± 0.136 vs. HS 0.291 ± 0.062 w/kg p < 0.05). Conclusion: During gait PwMS have synergies numbers similar to healthy persons. Their neurological deficit alters modular control through modifications of the timing activation profiles rather than module composition. These changes were associated with their main walking impairment, muscle weakness, and prolonged double support.

Effects of functional electrical stimulation on reducing falls and improving gait parameters in multiple sclerosis and stroke

Loss of neuromuscular control of the ankle joint is a common impairment in neurologic conditions, leading to abnormal gait and a greater risk of falling. Limited information, however, is available on the effectiveness of functional electrical stimulation (FES) on reducing falls, and no studies have investigated its usefulness in improving lower limbs kinematics related to foot clearance and energy recovery.

Effects of Sudden, Passive Muscle Shortening According to Grimaldi's Method on Patients Suffering from Multiple Sclerosis: A Randomized Controlled Trial

Purpose. The purpose of this study was to investigate the short-term effect of a therapeutical approach called “Grimaldi’s method.” The authors hypothesized that Grimaldi’s method would improve active muscle recruitment. The treatment was focused on hip abductors. The authors collected data of hip’s active range of motion against gravity (AROM), maximum isometric endurance (END), and maximum mechanical work (WORK). Participants and methods. Forty patients suffering from multiple sclerosis were randomized into 2 groups, 20 were allocated to the Grimaldi’s group and 20 to the control group. Results. After 3 sessions of Grimaldi’s treatment parameter, AROM increased from 21.4° to 37.2° in the experimental group; the improvement was statistically significant. Parameter END did not show any improvement, whereas mechanical work had a sharp increase: from 103.9 Nm to 149.6 Nm. Conclusion. The findings suggest that Grimaldi’s method could be useful in increasing muscular recruitment of hip abductors, improving active range of motion and mechanical work of the hip in patients suffering from multiple sclerosis.