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Background and purpose Respiratory disorders are a major cause of morbidity and mortality in multiple sclerosis ( MS). Mainly reported in walking patients, they are poorly explored when walking is severely impaired. To characterize respiratory impairment in patients with advanced MS. Methods From 2012 to 2015, patients with MS with an Expanded Disability Status Scale (EDSS) score of ≥7 who were referred for functional and rehabilitation evaluation underwent pulmonary function tests to study lung volumes, cough efficacy and respiratory muscle pressures. Results Among 73 patients with a median EDSS score of 8 [7.5; 8.5], 72.6% had impaired respiratory function with a mean vital capacity ( VC) of 57.9 ± 33.5% of theoretical value. Severe impairment ( VC < 50%) was found for 34 (46.6%) patients. Cough was impaired in 45 (61.6%) patients, with a mean cough peak flow of 3.14 ± 1.9 L/s and severe impairment (cough peak flow < 2.67 L/s) in 27 (37.0%) patients. Overall, the results suggested predominant expiratory muscle dysfunction and non-predominant diaphragm impairment. EDSS score was correlated with VC but not with any other clinical data. Conclusion Restrictive respiratory failure is frequent in severely impaired patients with MS, predominantly involves expiratory muscles, does not involve diaphragm weakness and is associated with cough impairments. [ABSTRACT FROM AUTHOR]

Abstract: The ability to rapidly establish a memory link between arbitrary sensory cues and goal-directed movements is part of our daily motor repertoire. It is unknown if this ability is affected by middle cerebral artery stroke. Eighteen right-handed subjects with a first unilateral middle cerebral artery stroke were studied while performing a precision grip to lift objects of different weights. In a “no cue” condition, a noninformative neutral visual stimulus was presented before each lift, thereby not allowing any judgment about the object weight. In a “cue” condition arbitrary color cues provided advance information about the weight to be lifted in the subsequent trial. Subjects performed both conditions with either hand. During “no cue” trials subjects scaled their grip force according to the weight of the preceding lift, irrespective of the hand performing the lift or the hemisphere affected. The presentation of color cues allowed patients with right hemispheric stroke, but not those with left hemispheric stroke, to scale their grip force according to the weight in the upcoming lift when lifting the weight with the unaffected hand. Color cues did not allow for a predictive scaling of grip force according to the weight of the object to be lifted when lifting with the affected hand, irrespective of the affected hemisphere. These data imply that the ability of visuomotor mapping in the grip-lift task is selectively impaired in the affected hand after right middle cerebral artery stroke, but in both hands after left middle cerebral artery stroke. [Copyright &y& Elsevier]

Abstract: Objective: To elaborate recommendations regarding neuropathic pain management in spinal cord injury patients. The goal was to evaluate the efficacy of local anesthetic therapeutics including intrathecal or epidural treatments, sympathetic and nerve blocks. Method: The methodology, proposed by the French Society of Physical Medicine and Rehabilitation (SOFMER), includes a systematic revue of the literature, the gathering of information regarding current clinical practice and a validation by a multidisciplinary panel of experts. Results: The results of the literature review do not validate the efficacy of clonidine, baclofen, morphine or lidocaine administered via intrathecal (IT) drug delivery or epidural injections on neuropathic pain in spinal cord injury patients. One reason could be the methodological limitations of the studies. Another reason could be that in most cases the evaluation is done after one single dose injection, thus preventing the authors from assessing the efficacy of the treatments on the long-term. Various clinical practices experiences lead us into thinking that there is, in some cases, a real efficacy for IT baclofen delivery, but this still remains to be properly defined in terms of patients characteristics and type of neuropathic pain. Regarding anesthetic nerve root blocks and sympathetic blocs, no element is available to validate the efficacy of these techniques. Conclusion: There is not a sufficient level of proof to recommend using IT or epidural drug delivery for treating neuropathic pain. However, according to the clinical practices data reviewed, we can suggest to conduct further studies on the impact of IT baclofen delivery that seems to have a pain-relieving impact in some situations. It would be interesting to identify the subgroups of patients that could benefit from this treatment. [Copyright &y& Elsevier]

Study design:Two case reports of aseptic meningitis after intrathecal baclofen injection.Objectives:To report an unusual complication of intrathecal baclofen injection during test injections.Setting:Department of Neurological Rehabilitation, R Poincaré Hôpital (Paris-Ile de France-Ouest University).Case reports:We present two cases of chemical meningitis after intrathecal baclofen injections by lumbar puncture. These cases presented with febrile meningeal syndromes during the 24 h following intrathecal baclofen injection. Direct cerebrospinal fluid (CSF) examination and CSF cultures were negative. An intense cellular reaction was observed with a marked predominance of neutrophils. Meningitis resolved spontaneously over 3–4 days.Conclusions:Chemical meningitis is a rare complication of intrathecal baclofen injections that must be recognized. It is a diagnosis of exclusion and its pathophysiological mechanism remains unclear.Spinal Cord (2006) 44, 330–333. doi:10.1038/sj.sc.3101838; published online 20 September 2005 [ABSTRACT FROM AUTHOR]

Reports a case of superior mesenteric artery syndrome (SMA) in a paraplegic patient which occurred several months after spinal cord injury, during the rehabilitation program. Review of literature of SMA syndrome in spinal cord injured patients; Basis of the diagnosis; Factors of SMA syndrome.

Introduction/Background The TOWER study ( NCT01603459 ) previously demonstrated that escalating doses of incobotulinumtoxinA (400–≤800 U) in patients with upper- (UL) and lower-limb (LL) spasticity due to stroke or other cerebral causes increased treatment efficacy without compromising safety or tolerability (Wissel, Neurology 2017). This post-hoc analysis assessed the efficacy of incobotulinumtoxinA for LL spasticity, including pes equinovarus. Material and method Patients received treatment with escalating total incobotulinumtoxinA doses on the same body side during three injection cycles (ICs) (400 U, 600 U and 600–800 U, respectively; maximum 600 U per limb; optional pes equinovarus, planned dose range 100–400 U). Outcomes included change from IC baseline to 4 weeks post-injection in Ashworth Scale (AS) for the ankle joint (in patients treated for pes equinovarus or not) and LL resistance to passive movement scale (REPAS) scores (in patients treated in the LL [with/without UL treatment], or UL only). Results In total, 155 patients were enrolled. In IC1, IC2 and IC3, respectively, 109, 137 and 137 patients received LL treatment with mean (standard deviation [SD]) total limb doses of incobotulinumtoxinA: 191.7 (97.6), 254.0 (111.6) and 320.9 (127.6) U. Pes equinovarus was treated in 88, 117 and 122 of these patients. The mean (SD) improvement in ankle joint AS score at 4 weeks post-injection was –0.66 (0.77), –0.70 (0.82) and –0.82 (0.77) in patients treated for pes equinovarus, and –0.21 (0.64), –0.38 (0.85) and –0.61 (0.70) in patients who were not, with a significant difference between the groups in IC1 ( P = 0.0006). For all ICs, the mean improvement in REPAS LL scores 4 weeks post-injection was greater in patients who were treated in the LL than in patients treated in the UL only, with significant differences between groups in IC1 ( P < 0.0001) and IC2 ( P = 0.0043). Conclusion Results suggest that incobotulinumtoxinA is effective for treating LL spasticity, including pes equinovarus. [ABSTRACT FROM AUTHOR]

Introduction/Background Fatigue and fatigability are common problems in patients with multiple sclerosis (MS). The aim of this study was to explore the impact of a combined rehabilitation program on fatigue and on fatigability of knee extensor muscles in patients with MS. Material and method Twenty-three patients with MS were included in this study. Knee extensor muscles strength and fatigability were assessed using an isokinetic ergometer and perceived fatigue was assessed with a self-reported fatigue scale (Modified Fatigue Impact scale) before and after the rehabilitation program. The combined rehabilitation program included sessions on balance and gait training; sessions of endurance and resistance training. Results After rehabilitation, fatigue decreased significantly, on the other hand, torque fatigability index increased. Strength at the beginning of the fatigability protocol increased but strength at the end of the fatigability protocol did not change. Conclusion Combined rehabilitation program increased strength and decreased fatigue. However, torque fatigability index increased because the program enhanced strength at the beginning of the fatigability protocol but not at the end of the fatigability protocol. [ABSTRACT FROM AUTHOR]

Introduction/Background Computer access is important for social participation for people with cervical spinal cord injury (SCI). Different devices have been developed to enable them to use a computer but text input speed (TIS) with them is low. Several methods [e.g., word prediction software (WPS)] have been developed to increase TIS. In the literature, the effect of WPS on TIS was debatable. One hypothesis to explain the disparity is the lack of specific WPS-training programs for people with cervical SCI. Material and method The aim of this study was to compare the influence of three WPS-training programs on TIS in people with cervical SCI, and to determine which was the most effective. Participants were randomized to one of three different groups: a group with training with an occupational therapist (REHAB), a group with a standardized home self-training with a written training guide (SELF), and a third group that had no training (CONTROL). Results Forty-two participants were included and 38 completed the study. TIS improved significantly more in the REHAB group (with and without WPS) than in the CONTROL ( P < 0.001) and SELF groups ( P < 0.001) between D0 and D30. Conclusion The results of this study showed that OT-supervised training improved TIS but did not provide any specific improvements in the use of WPS on TIS, although the number of recorded errors decreased when using WPS after training and the improvement of the rate of word prediction use. These results suggest that supervised training should be developed when providing patients with word prediction software, in order to increase their TIS. [ABSTRACT FROM AUTHOR]

Introduction/Background Individuals with cervical spinal cord injury (ICSCI) have difficulty accessing computers through conventional methods. The purpose of this paper was to provide a critical narrative review on types of computer access devices and word prediction software for ICSCI. Material and method A search was conducted in several electronic databases. Results There is limited data about Test Input Speed (TIS) in ICSCI. One study showed that TIS in ICSCI was significantly lower [mean = 11 words per minute (wpm)] ( P = 0.001) than TIS of abled-bodied individuals (19 wpm). In a sample of ICSCI, there was a significant difference between voice recognition system (mean = 18 wpm), a standard keyboard (mean = 8 wpm) and an onscreen keyboard (mean = 3 wpm) ( P < 0.001). However, the literature suggested that the impact of Word Prediction Software (WPS) for increasing TIS remains questionable. Indeed, there is limited scientific documentation of the influence of the parameters of WPS on TIS. Regarding the number of words displayed in the prediction list, this parameter did not increase TIS. For the parameter “frequency of use”, use of WPS with the activation of frequency of use increased TIS in participants with high-level tetraplegia. For participants with low-level tetraplegia, the use of WPS with frequency of use activated only decreased the number of errors. Conclusion Each professional could provide clear and accurate information on the benefits of WPS for people with cervical SCI. WPS must be set regarding the needs of people with cervical SCI. If not, the use of these software's may go against the expected benefits. [ABSTRACT FROM AUTHOR]

Introduction/Background Increased muscle fatigability has been reported in patients with multiple sclerosis (MS) assessed during sustained isometric contractions however rehabilitation programs and daily life activities often involve concentric contractions. The aim of this study was to characterize knee extensor muscles fatigability in patients with MS during concentric contractions. Material and method Thirty-eight patients with MS and 14 healthy persons were included in this study. An isokinetic assessment of knee extensor muscles fatigability was carried out during a fatiguing task of 50 concentric contractions, associated with an electromyographic activity analysis of the rectus femoris, vastus lateralis, biceps femoris and semitendinosus muscles. Results Patients with MS experienced lower knee extensor muscles fatigability than healthy subjects. When torque was normalized to maximal isometric peak torque, patients with MS and healthy persons had the same level of relative strength at the end of the fatigue protocol (50% of the maximal isometric peak torque). During the fatiguing task neuromuscular efficiency decreased but coactivations of knee flexor muscles remained unchanged. Conclusion Fatigability is a common complaint in patients with MS but they experienced lower muscle fatigability than healthy persons during maximal concentric contractions, nevertheless they finished fatigue protocol at the same level of relative strength. [ABSTRACT FROM AUTHOR]

Introduction/Background Botulinum neurotoxin is well established for treating upper limb spasticity. However, few studies have assessed efficacy in the shoulder. TOWER ( NCT01603459 ) previously evaluated the safety and efficacy of escalating incobotulinumtoxinA doses (400U– ≤ 800U) in adults with upper- and lower limb spasticity due to cerebral causes (Wissel. Neurology , 2017). This post-hoc analysis assessed the efficacy and safety of incobotulinumtoxinA for treating shoulder spasticity, as part of upper limb treatment. Material and method Patients received three injection cycles (IC) with escalating incobotulinumtoxinA doses on the same body side (400U, 600U and 600–800U; ≤ 600U per limb including optional shoulder dose, planned range 100–250U). Here, patients who had received shoulder treatment were compared with those who had upper limb treatment, without shoulder treatment. Ashworth Scale (AS) scores for shoulder adduction, extension and internal rotation were added to form the AS shoulder sum score (AS-SSS), to fully assess joint function. The incidence of adverse events (AEs) was assessed. Results The number of patients receiving shoulder treatment increased with escalating incobotulinumtoxinA dose at each IC, peaking in IC3 ( n = 84/140 [60.0%]; mean [SD] shoulder dose 118.4 [60.2] U). From baseline to 4 weeks post-injection in IC1, IC2 and IC3, respectively, the mean (SD) AS-SSS improved by −1.1 (1.9), −1.7 (1.8) and −1.7 (1.8) in patients treated in the shoulder and −0.5 (1.3), −0.8 (1.6) and −0.9 (1.4) in patients who were not. Multiple regression analysis adjusting for IC baseline showed significant improvement in AS-SSS with incobotulinumtoxinA shoulder dose in IC3 ( P = 0.0081). AEs occurred in 52.1% of patients treated in the shoulder and 61.0% in those who were not. No differences were observed in AE patterns and no unexpected safety concerns were reported with shoulder treatment or higher incobotulinumtoxinA dose. Conclusion Results support the efficacy and safety of incobotulinumtoxinA for treatment of shoulder spasticity as part of upper limb treatment. [ABSTRACT FROM AUTHOR]

Introduction/Background Effective treatment of disabling, multifocal upper- and/or lower limb spasticity may require botulinum neurotoxin doses higher than those indicated currently. TOWER ( NCT01603459 ) previously investigated the safety and efficacy of escalating incobotulinumtoxinA doses (400– ≤ 800U) in adults with upper- and lower limb spasticity due to stroke or other cerebral causes (Wissel. Neurology , 2017). Here, we report further data regarding the impact of escalating doses on multi-pattern treatment and muscle dosing. Material and method Treatment comprised three injection cycles (ICs) with escalating total doses on the same body side, each followed by 12–16 weeks’ observation: IC1, 400U into the upper limb and/or lower limb; IC2, 600U into the upper limb and/or lower limb; and IC3, 600–800U into the upper and lower limbs (maximum 600U per limb). At screening, investigators selected a target clinical pattern for treatment in all ICs. Other patterns were treated at the investigator's discretion. Results In total, 155 patients (mean [SD] age, 53.7 [13.1] years) were enrolled, with spasticity due to stroke (85.2%) or other cerebral causes (14.8%). The number of clinical patterns and muscles treated increased with escalating dose at each IC. In IC1, IC2 and IC3, respectively, 608, 743 and 811 clinical patterns and 46, 49 and 53 different muscles were treated in 155, 152 and 140 patients. The number of patients treated for the most frequently injected clinical patterns in the upper (flexed elbow) and lower limb (pes equinovarus), respectively, increased from 75.5% and 56.8% of patients in IC1 to 88.6% and 87.1% in IC3. Conclusion Escalating incobotulinumtoxinA doses enabled a more comprehensive multi-pattern treatment approach, with an increase of approximately 33% in clinical patterns and more muscles treated with the highest dose (600–800U) versus the initial dose (400U) in patients with upper- and lower limb spasticity. [ABSTRACT FROM AUTHOR]

Background According to treatment guidelines in spasticity management, botulinum toxin injections should be offered as a treatment option for focal spasticity. In severe combined upper and lower limb or in multifocal spasticity, doses required to improve goal achievement and fulfil patients’ needs can result in total doses exceeding those currently approved, which are in France 360 U for onabotulinumtoxin A 400 U for incobotulinumtoxin A and 1500 U for abobotulinumtoxin A. Therefore, the challenges of treating patients with multifocal spasticity with botulinum toxin type A increase with the number of disabling patterns. Physicians may need to prioritize treating patterns with a high impact on overall goal achievement. Methods TOWER is a prospective, open-label, non-randomized, single-arm, multicenter, dose-titration phase III study with the aim to investigate the safety and efficacy of incobotulinumtoxinA in the treatment of spasticity in patients who are deemed to require total body doses of up to 800 U. The study employs a dose-titration approach over three injection cycles with a fixed total body dose of 400 U of incobotulinumtoxinA for injection cycle 1, 600 U for cycle 2 and 800 U for cycle 3 with a maximum dose per limb of 400 U in cycle 1 and 600 U in cycle 2 and 3. Results One hundred and fifty-five patients aged 18–80 years with spasticity of the upper and lower limb of the same body side due to cerebral causes and having to deemed by the investigator to require total body doses of incobotulinumtoxinA 800 U during the course of the trial, participate at 30 study sites in Canada, France, Germany, Italy, Norway, Portugal, Spain, and the USA. Results of the cycle with 800 U show that the number of patterns treated is higher with this cycle than at the cycle with 600 U. The same results are found between the cycle with 600 U and 400 U. Conclusion Many physicians would like to be allowed greater dosing flexibility to improve treatment satisfaction for a subset of patients with post-stroke spasticity. Results from TOWER study show that the treated number of patterns is higher with this cycle than the cycle with 600 U. The same results are found between the cycle with 600 U and 400 U. [ABSTRACT FROM AUTHOR]

Objectives To estimate the quality of health prevention among persons with severe motor disabilities. Methods Descriptive study conducted by questionnaire among adults from 18 to 74 years old, users of wheelchair. Survey led from June 2013 until June 2014, on various sites of Île-de-France (specialized hospitals, “SAMSAHs”, “MAS”, “Salon Autonomic”). Results The study population included 145 persons. If cardiovascular prevention (screening for hypertension, current smoking and dyslipidemia) appears to be satisfactory, the same cannot be said for other prevention topics such as vaccinations, gynecological follow-up or cancer screening. Only 53% of respondents thought their vaccinations were up to date, 28% thought their vaccinations were not and 18% did not know. Among the 57 women in our study, only 26% had had a gynecological examination within a year. Among the women aged 50 to 74 in our sample, 22 of 34 (64,7%) had done a mammography in the previous 2 years. Of the 26 women in our sample involved by cervical cancer screening, only 15 (57,7%) had made a smear in the past 3 years. Regarding the colorectal cancer screening, among people aged 50 to 74 with no history of colonoscopy, only 9 of 47 (19%) had made an Hemoccult test within 2 years. Discussion Our results concerning the vaccinations are less good than those observed in the investigation “Health Barometer 2010 [1] ” led in general population: in our study, vaccinations appear less often up to date and more frequently unknown. Our participation rates reported for cancer screening are lower than those observed in the “Cancer Barometer 2010 [2] ” where they reached 87.5% for mammography, 81.4% for smears and 44.5% for colorectal cancer screening test. Health prevention should be improved with people with severe motor disabilities by organizing regular checkups on prevention and improving the accessibility of health care settings. [ABSTRACT FROM AUTHOR]

Background Respiratory disorders in multiple sclerosis (MS) are an important issue. They can occur early during the course of the disease, are associated with the neurological impairment, and can lead to pneumonia and respiratory failure, which are the main causes of death in advanced MS. Prevailing impaired expiratory muscles and cough abilities has been demonstrated in this population and might constitute a specific target for rehabilitation interventions. However, international guidelines lack recommendations regarding respiratory rehabilitation in MS. Here we performed a systematic review of the published literature related to respiratory rehabilitation in MS. Methods We searched the databases MEDLINE via PubMed, PEDro and Cochrane Library for English or French reports of clinical trials and well-designed cohorts published up to December 2016 with no restriction on start date by using the search terms “multiple sclerosis”, “respiratory rehabilitation”, “respiratory muscle training”, “lung volume recruitment”, “cough assistance”, and “mechanical in-exsufflation”. Literature reviews, case reports and physiological studies were excluded. The Maastricht criteria were used to assess the quality of clinical trials. We followed the Oxford Centre for Evidence-Based Medicine guidelines to determine level of evidence and grade of recommendations. Results Among the 21 reports of studies initially selected, 11 were retained for review. Seven studies were randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a portable resistive mouthpiece was the most frequently evaluated technique, with 2 level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All reviewed studies evaluated home-based rehabilitation programs and focused on spirometric outcomes. The disparities in outcome measures among published studies did not allow for a meta-analysis and cough assistance devices were not evaluated in this population. Conclusion Although respiratory muscle training can improve maximal respiratory pressure in MS and lung volume recruitment can slow the decline in vital capacity, evidence is lacking to recommend specific respiratory rehabilitation programs adapted to the level of disability induced by the disease. [ABSTRACT FROM AUTHOR]

Abstract: Some recent studies in children with spasticity demonstrated the safety of multimuscle injections of botulinum toxin (BT) type A with doses markedly higher than those recommended. Data about efficacy and safety of multifocal injections of BT in adult patients with spasticity are very limited. However numerous clinical situations for example, spinal cord injury, multiple sclerosis, brain injury, stroke or cerebral palsy seem to justify this type of patient management. Controlled studies are expected in the future to evaluate the efficacy and safety of multisite injections of BT. They may encourage physicians to perform such multifocal injections with high doses of BT. A better understanding of distant spread of BT is also warranted. [Copyright &y& Elsevier]

• Instrumental motion analysis is important to improve understanding of the relationship between muscle overactivity and abnormal movement. • Instrumental motion analysis is useful to assess focal and global gait abnormalities. • Instrumental motion analysis is insufficiently used for the analysis of upper-limb movement because of the many degrees of freedom of the upper limb and the lack of a standardized task. Muscle overactivity is a general term for pathological increases in muscle activity such as spasticity. It is caused by damage to the central nervous system at the cortical, subcortical or spinal levels, leading to an upper motor neuron syndrome. In routine clinical practice, muscle overactivity, which induces abnormal muscle tone, is usually evaluated by using the Modified Ashworth Scale or the Tardieu Scale. However, both of these scales involve testing in passive conditions that do not always reflect muscle activity during dynamic tasks such as gait or reaching. To determine appropriate treatment strategies, muscle overactivity should be evaluated by using objective measures in dynamic conditions. Instrumental motion analysis systems that include 3-D motion analysis and electromyography are very useful for this purpose. The method can be used to identify patterns of abnormal muscle activity that can be related to abnormal kinematic patterns. It allows for objective and accurate assessment of the effects of treatments to reduce muscle overactivity on the movement to be improved. The aim of this point-of-view article is to describe the utility of instrumental motion analysis and to outline both its numerous advantages in evaluating muscle overactivity and to present the current limitations for its use (e.g., cost, the need for an engineer, errors relating to marker placement and cross talk between electromyography sensors). [ABSTRACT FROM AUTHOR]

Introduction/Background Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews for effectiveness of non-pharmacological interventions for improved spasticity outcomes. Material and method A literature search was conducted using medical and health science electronic databases for published systematic reviews up to 15th June 2017. Two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Results Overall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is ‘moderate’ quality evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care in persons following stroke. ‘Low’ quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with multiple sclerosis, vibration therapy for spinal cord injury and stretching for other neurological condition. For other interventions, evidence was inconclusive. Conclusion Despite non-pharmacological interventions are used for various neurological conditions, there is still lack of high-quality evidence for many. Further research is needed to judge the effect with appropriate study designs and intensity and associate costs of these interventions. [ABSTRACT FROM AUTHOR]

Introduction/Background Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke especially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Material and method A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. Two hundred and twenty subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurrence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2 hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1 h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self-rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results Two hundred and eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not significantly different at day 30 nor any other secondary criteria except ARAT. Conclusion An additional time 1 h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study. [ABSTRACT FROM AUTHOR]

Introduction/Background Respiratory disorders in multiple sclerosis (MS) are an important issue. They can occur early during the course of the disease, are associated with the neurological impairment, and can lead to pneumonia and respiratory failure, which are the main causes of death in advanced MS. Prevailing impaired expiratory muscles and cough abilities has been demonstrated in this population and might constitute a specific target for rehabilitation interventions. However, international guidelines lack recommendations regarding respiratory rehabilitation in MS. We performed a systematic review of literature assessing respiratory rehabilitation in MS. Material and method We searched the databases MEDLINE, PEDro and Cochrane Library for reports of clinical trials and well-designed cohorts published from inception to December 2016, by using the search terms “multiple sclerosis”, “respiratory rehabilitation”, “respiratory muscle training”, “lung volume recruitment”, “cough assistance”, and “mechanical in-exsufflation”. Literature reviews, case reports and physiological studies were excluded. The Maastricht criteria were used to assess the quality of trials. We followed the Oxford Centre for Evidence-Based Medicine guidelines to determine level of evidence and grade of recommendations. Results Among the 21 studies initially selected, 11 were retained for review. Seven studies were randomized controlled trials (RCTs), 2 were non-RCTs, and 2 were observational studies. Respiratory muscle training (inspiratory and/or expiratory) by use of a portable resistive mouthpiece was the most frequently evaluated technique, with 2 level-1 RCTs. Another level-1 RCT evaluated deep-breathing exercises. All reviewed studies evaluated home-based rehabilitation programs and focused on spirometric outcomes. The disparities in outcome measures among published studies did not allow for a meta-analysis. Cough assistance devices were not evaluated in this population. Conclusion Although respiratory muscle training can improve maximal respiratory pressure in MS and lung volume recruitment can slow the decline in vital capacity, evidence is lacking to recommend specific respiratory rehabilitation programs adapted to the level of disability induced by the disease. [ABSTRACT FROM AUTHOR]

Background For people with cervical Spinal Cord Injury (SCI), access to computers can be difficult, thus several devices have been developed to facilitate their use. However, text input speed remains very slow compared to users who do not have a disability, even with these devices. Several methods have been developed to increase text input speed, such as Word Prediction Software (WPS). Health-Related Professionals (HRP) often recommend this type of software to people with cervical SCI. WPS can be customized using different settings. It is likely that the settings used will influence the effectiveness of the software on text input speed. However, there is currently a lack of literature regarding professional practices for the setting of WPS as well as the impact for users. The aim of this study is to analyze word prediction software settings used by HRP for people with cervical SCI. Method A questionnaire was submitted to HRP who advise tetraplegic people regarding the use of communication devices. Results A total of 93 professionals responded to the survey. The most frequently recommended software was Skippy, a commercially available software. HRP rated the importance of the possibility to customise the settings as high. Moreover, they rated some settings as more important than others ( p < 0.001). However, except for the number of words displayed, each setting was configured by less than 50% of HRP. Discussion and conclusion The results showed that there was a difference between the perception of the importance of some settings and data in the literature regarding the optimization of settings. Moreover, although some parameters were considered as very important, they were rarely specifically configured. Confidence in default settings and lack of information regarding optimal settings seem to be the main reasons for this discordance. This could also explain the disparate results of studies which evaluated the impact of WPS on text input speed in people with cervical SCI. [ABSTRACT FROM AUTHOR]

Background Different devices have been developed to enable persons with cervical spinal cord injury (SCI) to use a computer. However, text input speed (TIS) remains low for these persons. Several methods have been developed to increase TIS, such as word prediction software (WPS). Data in the literature are discordant regarding the effect of WPS on TIS, with decreases of up to 71% in some studies and increases of up to 45% in others. The main reason suggested for these differences is the cognitive load caused by the visual searching for words in the prediction list. It is thus likely that the number of words in the prediction list influences TIS. Moreover, WPS can be customized using different settings. For example, the prediction list can be ordered according to the frequency of occurrence of words in the language (frequency of use) and the automatic learning of new words can be activated. Until now, no studies in the literature have evaluated the influence of these parameters on TIS. The aims of this study are to determine if the number of words displayed in the WPS list and activation of the frequency of use and automatic learning parameters of WPS affects TIS in people with tetraplegia. Methods Forty-five persons with cervical SCI between C4 and C8 Asia AIS A or B and who were computer users were included. For the parameter “Number of Words displayed”, TIS was evaluated during 4 10-minute copying tasks (without WPS, with a display of 3 6 8 predicted words). For the parameter “frequency of use”, TIS was evaluated during 3 copying tasks (without WPS (WITHOUT), with automatic learning of words and frequency of use desactivated (NOT_ACTIV) or activated (ACTIV)). Results There was no effect of the number of words displayed in a word prediction list on TIS, however perception of TIS differed according to lesion level. Use of word prediction software with activation of frequency of use and automatic learning increased TIS in participants with high-level tetraplegia. Conclusion For participants with low-level tetraplegia, use of word prediction software with frequency of use and automatic learning activated only decreased the number of errors. [ABSTRACT FROM AUTHOR]

The aim of this prospective clinical study is to determine text input speed (TIS) in people with cervical Spinal Cord Injury (SCI) and to study the influence of participant's characteristics on TIS. People with cervical SCI were included if their level of injury was between C4 and C8 Asia AIS A or B, and were computer users. Each participant underwent a single evaluation using their usual computer access devices. TIS was evaluated during a 10-minute copying task. The relationship between participant's characteristics, computer access device and TIS were analyzed using a Two-Way ANOVA. In the study, 35 participants with cervical SCI and 21 able-bodied people were included. Participants with cervical SCI had a Median TIS was 11 [8.1; 17.2] wpm and able-bodied participants of 23.5 [18.1; 29.7] wpm ( p = 0.001). Participants with SCI lesions at or above C5 had a median TIS of 12.2 [4.5; 13] wpm and those with lesions below C5 had a median TIS of 10.4 [9.2; 18] wpm ( p = 0.38). The Two-Way ANOVA showed that only the type of computer access device significantly influence TIS. Surprisingly, none of the subject's characteristics among them the level of cervical lesion did not affect TIS. [ABSTRACT FROM AUTHOR]

Background During the clinical examination of stroke patients, it is common to observe that involuntary hip flexion occurs during voluntary ankle dorsiflexion (synkinesia). This suggests that there is a relationship between these two joints. We hypothesized that there may be a relationship between hip and ankle flexion during swing phase of the gait cycle. The objective of this study was to determine if there is a biomechanical relationship between peak hip flexion and peak ankle dorsiflexion during the swing phase of the gait cycle following stroke. Method The paretic lower limbs of 60 patients with stroke were evaluated using clinical tests and 3D-gait analysis. The clinical assessment included muscle strength, spasticity and passive range of ankle motion. The gait analysis focused on sagittal frontal and transverse kinematic gait parameters during swing. Findings A stepwise-linear-regression indicated that peak hip flexion and gait speed were the only 2 parameters which accounted for peak ankle dorsiflexion. There was also a significant negative correlation between peak hip flexion and peak ankle dorsiflexion during swing, and a significant positive correlation between hip flexor and ankle dorsiflexor muscle strength. Interpretation These results suggest that the biomechanical behaviour of hip and ankle joints during the swing phase of the gait cycle is linked in patients with stroke. They also suggest that two strategies exist: if sufficient ankle dorsiflexion is present, less hip flexion is required (distal-strategy) whereas if dorsiflexion is reduced, it is compensated for by an increase in peak hip flexion (proximal-strategy). [ABSTRACT FROM AUTHOR]

BACKGROUND: A dynamic-ankle-foot orthosis has recently emerged and consists of an elastic band allowing the variation of stiffness degree and adjusts dorsiflexion assistance in swing. The aim of this study was to quantify the biomechanical adaptations induced by this orthosis during gait in hemiplegic patients. METHODS: Twelve hemiplegic patients performed two gait analyses (without and with the ankle-foot orthosis). Spatiotemporal, kinematic, kinetic and electromyographic gait parameters were quantified using an instrumented gait analysis system during the stance and swing phases. RESULTS: During swing, peak ankle dorsiflexion was greater with the orthosis and associated with a decrease of pelvic obliquity angle. In stance, peak ankle plantarflexion and dorsiflexion were greater with the orthosis and associated with an increase of ankle angle at heel strike and toe-off. Electromyographic activities of both the tibialis anterior and the medial gastrocnemius were greater with the orthosis. CONCLUSIONS: This dynamic-ankle-foot orthosis improved gait in hemiplegic patients with spastic foot equinus. The spatiotemporal adaptations seem to be caused mainly by the increase of ankle dorsiflexion during stance and swing phases. The changes in electromyographic activity were related to an active dorsiflexion in stance and swing phases and an active plantarflexion in stance phase. [ABSTRACT FROM AUTHOR]

BACKGROUND: A dynamic-ankle-foot orthosis has recently emerged and consists of an elastic band allowing the variation of stiffness degree and adjusts dorsiflexion assistance in swing. The aim of this study was to quantify the biomechanical adaptations induced by this orthosis during gait in hemiplegic patients. METHODS: Twelve hemiplegic patients performed two gait analyses (without and with the ankle-foot orthosis). Spatiotemporal, kinematic, kinetic and electromyographic gait parameters were quantified using an instrumented gait analysis system during the stance and swing phases. RESULTS: During swing, peak ankle dorsiflexion was greater with the orthosis and associated with a decrease of pelvic obliquity angle. In stance, peak ankle plantarflexion and dorsiflexion were greater with the orthosis and associated with an increase of ankle angle at heel strike and toe-off. Electromyographic activities of both the tibialis anterior and the medial gastrocnemius were greater with the orthosis. CONCLUSIONS: This dynamic-ankle-foot orthosis improved gait in hemiplegic patients with spastic foot equinus. The spatiotemporal adaptations seem to be caused mainly by the increase of ankle dorsiflexion during stance and swing phases. The changes in electromyographic activity were related to an active dorsiflexion in stance and swing phases and an active plantarflexion in stance phase. [ABSTRACT FROM AUTHOR]