Hsieh-Ching Chen

Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery.

Chen CL, Chen HC, Tang SFT, Wu CY, Cheng PT, Hong WH: Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. Am J Phys Med Rehabil 2003;82:925–935. ObjectiveGait patterns vary among stroke patients. This study attempted to discover gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery. DesignData were gathered from 35 stroke patients and 15 healthy subjects. Gait performance and motor recovery were assessed 6 mos after stroke. Stroke patients further were divided into poor and good groups. The walking velocity was correlated with Brunnström’s stages, and the temporal stride and motion variables of the two groups were compared. ResultsWalking velocity was positively correlated with the Brunnström’s stages of the proximal lower limb. The poor group displayed slower walking velocity and shorter single-support time compared with the good group. Both groups displayed low maximum excursion of hip extension and ankle plantarflexion during the stance phase and low maximum excursion of hip and knee flexion and ankle dorsiflexion during the swing phase. Moreover, both groups displayed excessive pelvic tilts during the stance and swing phases. However, the poor group displayed different pelvic motion and timing sequences to each peak joint angle from normal subjects and the good group. Peak hip and knee angles of the affected limb during the stance phase occurred almost simultaneously in this group. ConclusionsSelective control of the proximal lower limb may be the main determinant of walking velocity. The compensatory adaptations were similar, except for pelvic motion, in stroke patients with different levels of motor recovery, whereas the poor group walked with synergistic mass patterns and reduced stability.

Randomized Trial of Distributed Constraint-Induced Therapy Versus Bilateral Arm Training for the Rehabilitation of Upper-Limb Motor Control and Function After Stroke

Background and Objective. This study compared the efficacy of distributed constraint-induced therapy (dCIT), bilateral arm training (BAT), and control treatment (CT) on motor control and functional performance of the upper limb in stroke patients. Methods. A total of 66 patients with mean stroke onset of 16.20 months and mild to moderate motor impairment were randomized to dCIT, BAT, or CT groups. Each group received treatment for 2 h/d and 5 d/wk for 3 weeks. Pretreatment and posttreatment measures included reaching kinematic variables in unilateral and bilateral tasks, the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Results. The dCIT and BAT groups had smoother reaching trajectories in the unilateral and bilateral tasks than the CT group. The BAT group, but not the dCIT group, generated greater force at movement initiation than the CT group during the unilateral and bilateral tasks. The dCIT patients had decreased WMFT time and higher functional ability scores than the CT patients. MAL results pointed to better performance in the amount and quality of use of the affected arm than BAT and CT patients. Conclusions. BAT and dCIT exhibited similar beneficial effects on movement smoothness but differential effects on force at movement initiation and functional performance. Therefore, BAT is a better option if improvement of force generation is the treatment goal, and dCIT is more appropriate for improving functional ability and use of the affected arm in daily life. These findings may assist in the planning of individually tailored rehabilitation therapies.

Influence of heel height and shoe insert on comfort perception and biomechanical performance of young female adults during walking

Background: The possible negative effects of high-heeled shoes on subjective comfort perception and objective biomechanical assessment have been noted. Although shoe inserts have been widely applied in footwear to increase comfort and to reduce the frequency of movement-related injury, no study has attempted to identify insert effectiveness in high heels. The purpose of this study was to determine the effects of heel height and shoe inserts on comfort and biomechanics as represented by plantar pressure and ground reaction force (GRF). Methods: Twenty young female adults performed the test conditions formed by the cross-matching of shoe inserts (shoe without insert and shoe with total contact insert [TCI]) and heel height (a flat, a low heel [3.8 cm] and a high heel [7.6 cm]). Two-way analyses of variance for repeated measures design were used to test condition effects on comfort rating, plantar pressure, and GRF during gait. To determine the biomechanical variables that can predict comfort, a multiple linear regression with stepwise method was done. Results: The results showed that discomfort increased with heel height. In high heels, the plantar pressure in the heel and midfoot shifted to the medial forefoot, and the vertical and anteroposterior GRF increased. Use of the TCI reduced the peak pressure in the medial forefoot. Interestingly, the effectiveness of the TCI was greater in the higher heels than in the lower heels and in flat heels. The peak pressure in the medial forefoot, impact force, and the first peak vertical GRF could explain 75.6% of the variance of comfort in high-heeled gait. Conclusions: These findings suggest that higher heels result in decreased comfort, which can be reflected by both the subjective rating scale and biomechanical variables. Use of a TCI altered the biomechanics and therefore improved the comfort in high-heeled shoes.

Effects of Modified Constraint-Induced Movement Therapy on Movement Kinematics and Daily Function in Patients With Stroke: A Kinematic Study of Motor Control Mechanisms

Background and Objective. Motor control of the upper extremity during unilateral and bimanual functional tasks and functional change during daily activities were evaluated in patients with stroke treated with modified constraint-induced movement therapy (mCIMT). Methods. In a pre-post randomized, controlled trial, 30 stroke patients received 2 hours of mCIMT or traditional rehabilitation (TR) for 3 weeks. Motor control of the upper extremity was evaluated using kinematic analysis in unilateral and bilateral tasks. Kinematic variables included spatial and temporal movement efficiency and type of movement control (preplanned control, representing well-learned movement, or feedback-guided control). Functional outcomes were evaluated using the Motor Activity Log (MAL) and the Functional Independence Measure (FIM). Results. Patients receiving mCIMT showed more temporally (P = .013) and spatially (P = .011) efficient movement and more preplanned movement control (P = .009) during the bimanual task, and greater gains in FIM (P = .004) and MAL scores (amount of use: P < .0001, and quality of movement: P = .012) than patients in the TR group. Patients receiving mCIMT produced more ballistic/preplanned reaching movement than did patients receiving TR (P = .023) during the unilateral task; but there were no group differences in temporal or spatial efficiency in unilateral task performance. Conclusions. Relative to TR, mCIMT produced a greater improvement in functional performance and motor control. Improvement of motor control after mCIMT was based on improved spatial and temporal efficiency, apparently more salient during bimanual rather than unilateral task performance. This suggests that bilateral task performance should potentially be emphasized in kinematic study of changes in motor control after mCIMT.

Effects of task goal and personal preference on seated reaching kinematics after stroke.

Background and Purpose— Current theories of motor control in rehabilitation focus on how the nervous system responds to many types of external and internal constraints to execute motor behavior to accomplish a task. However, the dynamic interplay between these 2 constraints remains unclear. This study examined the impact of some aspects of internal and external constraints on motor performance in persons with stroke. Methods— Twenty-seven persons with stroke used the uninvolved arms to perform an upper-extremity reaching task under 4 experimental conditions, formed by the crossing of functional goals and personal preferences. For the higher level of a functional goal, subjects took a drink from a can of beverage. For the lower level of a functional goal, subjects brought the can to the mouth without drinking. The level of personal preferences was determined, by interview, by the degree of predilection for particular beverages. Results— Significant and large effects of functional goals and personal preference were found in the variables of movement time and reaction time. However, the data trend of the 4 testing conditions varied according to presence of visuospatial neglect and side of lesion. Conclusions— Offering choices for the treatment activities and incorporating functional goals to therapeutic tasks might enhance response rate or movement efficiency, depending on the side of the lesion and presence of visuospatial neglect. The findings suggest that the consideration of the neglect phenomenon is a necessity when rehabilitative treatment planning incorporates constraint factors.

Effect of Therapist-Based Versus Robot-Assisted Bilateral Arm Training on Motor Control, Functional Performance, and Quality of Life After Chronic Stroke: A Clinical Trial

Background Although bilateral arm training (BAT) has been widely studied, the comparative effects of therapist-based BAT (TBAT) versus robot-assisted BAT (RBAT) remains unknown. Objective This study compared the efficacy of TBAT, RBAT, and a control treatment (CT) on motor control, functional performance, and quality of life after chronic stroke. Design A randomized, pretest-posttest, control group design was used. Methods Forty-two patients (mean age=54.49 years, SD=9.69; mean length of time since stroke onset=17.62 months, SD=10.50) were randomly assigned to TBAT, RBAT, and CT groups. Each group received treatment for 90 to 105 minutes per session, 5 sessions on weekdays, for 4 weeks. Outcome measures included kinematic analyses, the Fugl-Meyer Assessment (FMA), the Motor Activity Log, and the Stroke Impact Scale (SIS). Results Large and significant effects were found in the kinematic variables, distal part of upper-limb motor impairment, and certain aspects of quality of life in favor of TBAT or RBAT. Specifically, the TBAT group demonstrated significantly better temporal efficiency and smoothness, straighter trunk motion, and less trunk compensation compared with the CT and RBAT groups. The RBAT group had increased shoulder flexion compared with the CT and TBAT groups. On the FMA, the TBAT group showed higher distal part scores than the CT group. On the SIS, the RBAT group had better strength subscale, physical function domain, and total scores than the CT group. Limitations This study recruited patients with mild spasticity and without cognitive impairment. Conclusions Compared with CT, TBAT and RBAT exhibited differential effects on outcome measures. Therapist-based BAT may improve temporal efficiency, smoothness, trunk control, and motor impairment of the distal upper limb. Robot-assisted BAT may improve shoulder flexion and quality of life.

Ergonomic risk factors for the wrists of hairdressers

This study utilized a portable data logger to measure the wrist angles and forearm flexor and extensor electromyography (EMG) of 21 hairstylists. The hairstylists were divided into two groups, one with 11 barbers (9 males and 2 females) specializing in mens hairdressing, and one with 10 hairdressers (2 males and 8 females) specializing in womens hairdressing. The standard haircut task was divided into three subtasks: hair cutting, washing and blow-drying. The mechanical exposures of the overall task and subtasks were quantified to compare how subtasks, occupational groups, and gender groups differ. Experimental results show that the average time to finish a womans haircut (51.4min) is significantly longer than that for a mans haircut (35.6min) (p<0.005). Female hairstylists had significantly greater EMG activity than male hairstylists did (p<0.001). The non-dominant hands of hairdressers have significantly higher overall wrist velocity than those of barbers (p<0.005). Analytical results suggest that the relatively higher force exertion and wrist velocity of female hairstylists combined with prolonged exposure may account for the higher rate of hand/wrist pain in female hairdressers than in male barbers.

Effect of therapist-based constraint-induced therapy at home on motor control, motor performance and daily function in children with cerebral palsy: a randomized controlled study

Objective: To determine the effect of therapist-based constraint-induced therapy at home on motor performance, daily function and reaching control for children with cerebral palsy. Design: A single-blinded, randomized controlled trial. Subjects: Forty-seven children (23 boys; 24 girls) with unilateral cerebral palsy, aged 6–12 years, were randomized to constraint-induced therapy (n = 24) or traditional rehabilitation (n = 23). Interventions: Constraint-induced therapy involved intensive functional training of the more affected arm while the less affected arm was restrained. Traditional rehabilitation involved functional unilateral and bilateral arm training. Both groups received individualized therapist-based interventions at home for 3.5–4 hours/day, two days a week for four weeks. Main measures: Motor performance and daily function were measured by the Peabody Developmental Motor Scale, Second Edition and the Pediatric Motor Activity Log. Reaching control was assessed by the kinematics of reaction time, movement time, movement unit and peak velocity. Results: There were larger effects in favour of constraint-induced therapy on motor performance, daily function, and some aspects of reaching control compared with traditional rehabilitation. Children receiving constraint-induced therapy demonstrated higher scores for Peabody Developmental Motor Scale, Second Edition – Grasping (pretest mean ± SD, 39.9 ± 3.1; posttest, 44.1 ± 2.8; P < 0.001), Pediatric Motor Activity Log (pretest, 1.8 ± 0.3; posttest, 2.5 ± 0.3; P < 0.001) and shorter reaction time, normalized movement time (P < 0.001) and higher peak velocity (P = 0.004) of reaching movement. Conclusions: Constraint-induced therapy induced better grasping performance, daily function, and temporal and spatiotemporal control of reaching in children with unilateral cerebral palsy than traditional rehabilitation.

Pilot Comparative Study of Unilateral and Bilateral Robot-Assisted Training on Upper-Extremity Performance in Patients With Stroke

We compared a unilateral robot-assisted training protocol (URTP) and a bilateral robot-assisted training protocol (BRTP) to study their differential effects. We recruited 21 patients with stroke who received 90-105 min of therapy 5 days/wk for 4 wk. Participants in the URTP and BRTP groups practiced forearm pronation and supination and wrist flexion and extension in a simultaneous manner with the Bi-Manu-Track. The control group received standard rehabilitation. Clinical measures included the Fugl-Meyer Assessment, the Medical Research Council instrument, grip strength, and the Modified Ashworth Scale to assess motor impairment, muscle power, muscle strength, and spasticity, respectively. The pilot study indicated that the URTP and BRTP might have differential benefits for movement improvement. URTP might be a more compelling approach to improving upper-limb motor impairment, muscle power, and strength at the distal joints than BRTP, whereas BRTP could be an optimal approach to improving proximal muscle power.

Relative and Absolute Reliabilities of the Myotonometric Measurements of Hemiparetic Arms in Patients With Stroke

OBJECTIVE To investigate the relative and absolute reliabilities of the myotonometer. DESIGN Psychometric study. SETTING Three medical centers. PARTICIPANTS Patients with stroke (N=61). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Muscle tone, elasticity, and stiffness of relaxed affected deltoid, triceps brachii, biceps brachii, extensor digitorum, flexor carpi radialis, and flexor carpi ulnaris were measured twice, 30 minutes apart, using the myotonometer. Intraclass correlation coefficient, a relative reliability index, was calculated for 3 muscular properties and for each muscle to examine the degree of consistency and agreement between the 2 test sessions. Absolute reliability indices, including the SEM, smallest real difference, and Bland-Altman limits of agreement, were used to quantify measurement errors and check systematic biases of the 2 test sessions. RESULTS The intraclass correlation coefficients were .83 to .95 for muscle tone, elasticity, and stiffness of all muscle groups. The SEM and the smallest real difference of muscle tone, elasticity, and stiffness of the biceps were the smallest among the 6 muscles tested. The Bland-Altman analyses showed no systematic bias between most of the repeated measurements. Compared with other muscles, biceps had narrower limits-of-agreement ranges, indicating that the myotonometric measurements of the biceps had higher stability and less variation over time. CONCLUSIONS The myotonometer reliably measures muscular properties, with good relative and absolute reliabilities. These findings are useful for clinicians and researchers to assess muscle properties reliably and determine whether a real change has occurred in groups and on individual levels of patients with stroke.