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Background Mobile applications may be used to assess gait pattern deviation through mobile smartphones in people with Parkinson’s disease (PD). However, few studies have investigated their psychometrics properties. Research question To study the construct validity and test-retest reliability of the RUNZI® free mobile application in people with mild to moderate PD. Methods Thirty individuals were evaluated with the RUNZI® app and with the 10-meter walking test (10 MW), simultaneously. In addition, the Timed Up & Go test (TUG), Tinetti scale, and the Berg Balance Scale (BBS) were used to study the construct validity. Also, test-retest reliability of the mobile for spatio-temporal gait parameters was explored. Results The correlation indices of the 10 MW test with the RUNZI® app at fast speeds was moderate to excellent (r = .588–.957). At a comfortable speed, the correlation was excellent for walking speed (r = 0.944), moderate for steps (r = 0.780) and stride length (r = 0.760), and poor for cadence (r = .424). Results showed significant correlations between TUG and spatio-temporal gait parameters at fast and comfortable speeds. There were no significant correlations or consistent associations between Tinetti and BBS and RUNZI®. The test-retest reliability was good to excellent for parameters measured with the RUNZI®. Significance Our findings highlight specific opportunities for a free smartphone-based spatio-temporal gait analysis to serve as a complement to conventional gait analysis methods in clinical practice with a moderate to excellent construct validity with the 10 MW test and good to excellent test-retest reliability in PD patients.

Resumen Introduccion El patron de la marcha se ve alterado en los sujetos con amputacion de la extremidad inferior. Para su evaluacion es importante el uso de escalas de observacion de la marcha con una buena validez de contenido. Objetivos Disenar una escala de observacion de la marcha atendiendo a las principales alteraciones de la marcha de los sujetos con amputacion y analizar su validez de contenido. Material y metodos Para obtener una version de la escala se conformo un comite de expertos. El mismo comite se ocupo de la evaluacion de la escala. Se calculo el indice de validez de contenido (IVC), tanto para cada item como para la escala global. Resultados Se seleccionaron las principales alteraciones cinematicas y espaciotemporales para el desarrollo de los items. La escala se compone de 2 secciones y 25 items, con una puntuacion maxima de 35 puntos. Se obtuvo una puntuacion global IVC de 0,90, y un indice de validez para la mayoria de los items con valores superiores a 0,78. Conclusion La Escala observacional de la marcha del sujeto con amputacion de la extremidad inferior ha mostrado una validez de contenido excelente de acuerdo con el IVC obtenido. Futuros estudios deben evaluar su fiabilidad y validez de constructo.

Objective: Vojta therapy describes stereotypic widespread motor responses as a pattern of tonic muscle contractions during a peripherical pressure stimulation. The present work proposes to characterize the responses at muscles level to a specific tactile input based on Vojta therapy, assessed by sEMG, compared to a sham stimulation in healthy subjects. Methods: Surface electromyography (sEMG) signal was acquired with dipolar electrodes placed at wrist extensors of both forearms, right tibialis anterior, and top part of rectus abdominus, ground channel placed over the right olecranon. It was amplified and digitized by a 4-channel hub Biosignalsplux device (Plux Wireless Biosignals S.A., Lisboa, Portugal), sampled at 1000 Hz with 16-bit per channel. A continuous 10-minute record of the sEMG signal from the four electrodes were registered. Resting EEG during the first minute before the stimulation period was recorded by 64 active electrodes. Results: Statistically significant differences were showed between sham and experimental group. Experimental group participants were subjected to cluster analysis based on their muscle activation patterns, generating three different models of activation. Differences in the previous resting cortical activity in left superior frontal area were found between clusters that activated limb muscles and the cluster that did not. Conclusions: Vojta specific stimulation area activates innate muscle responses assessed by sEMG in healthy subjects, compared to a sham stimulation. Significance: This characterization might be helpful to the prescription and application of Vojta therapy in an individual-basis for non-neurophysiologically damaged adult subjects.

Few studies have investigated the psychometric properties of the Scale for Contraversive Pushing (SCP) in depth, and none have evaluated its ability to establish differential diagnosis between pusher behavior (PB) and thalamic astasia (TA).: To study the ability of the SCP to establish differential diagnosis, its reliability, content, construct, and internal validity in the assessment of subacute stroke patients.: 120 individuals were evaluated using the SCP over a four-week period of treatment. Intra- and inter-observer reliability, floor and ceiling effects, minimum detectable change (MDC), internal validity and sensitivity to change were explored. In addition, the Barthel Index and the Trunk Control Test were used to study their correlations with the SCP.: Discriminant validity provides evidence that the correlation between SCP items was large or moderate. Convergent validity demonstrated that the correlation of each item with the total score of the scale was high (at around 0.8). Sensitivity to change was large (W = 0.274). Intra- and inter-observer reliability were excellent (Intraclass Correlation Coefficient0.9; k0.8), except for items B standing and C sitting (k 0.7). The MDC was 1.39, and ceiling (8.333%) and floor (15.833%) effects were adequate. Cronbach's alpha (α) was equal to 0.901 (0.874-0.924) and McDonald's Omega (ω) was equal to 0.883 (0.856-0.973), showing excellent internal consistency.: The SCP is a reliable and valid tool which can successfully establish differential diagnosis between PB and TA and evaluate the changes generated by physiotherapy treatment.

Background Brain-computer interface (BCI) systems have been suggested as a promising tool for neurorehabilitation. However, to date, there is a lack of homogeneous findings. Furthermore, no systematic reviews have analyzed the degree of validation of these interventions for upper limb (UL) motor rehabilitation poststroke. Objectives The study aims were to compile all available studies that assess an UL intervention based on an electroencephalography (EEG) BCI system in stroke; to analyze the methodological quality of the studies retrieved; and to determine the effects of these interventions on the improvement of motor abilities. Type This was a systematic review. Literature Survey Searches were conducted in PubMed, PEDro, Embase, Cumulative Index to Nursing and Allied Health, Web of Science, and Cochrane Central Register of Controlled Trial from inception to September 30, 2015. Methodology This systematic review compiles all available studies that assess UL intervention based on an EEG-BCI system in patients with stroke, analyzing their methodological quality using the Critical Review Form for Quantitative Studies, and determining the grade of recommendation of these interventions for improving motor abilities as established by the Oxford Centre for Evidence-based Medicine. The articles were selected according to the following criteria: studies evaluating an EEG-based BCI intervention; studies including patients with a stroke and hemiplegia, regardless of lesion origin or temporal evolution; interventions using an EEG-based BCI to restore functional abilities of the affected UL, regardless of the interface used or its combination with other therapies; and studies using validated tools to evaluate motor function. Synthesis After the literature search, 13 articles were included in this review: 4 studies were randomized controlled trials; 1 study was a controlled study; 4 studies were case series studies; and 4 studies were case reports. The methodological quality of the included papers ranged from 6 to 15, and the level of evidence varied from 1b to 5. The articles included in this review involved a total of 141 stroke patients. Conclusions This systematic review suggests that BCI interventions may be a promising rehabilitation approach in subjects with stroke. Level of Evidence II

Background: Stroke is the leading cause of disability in adults, producing a major personal and economic impact on those affected. The scientific evidence regarding the use of Motor Imagery (MI) as a preparatory process for motor control reinforces the need to explore this method as a complement to physical therapy.Objectives: The objectives of this systematic review were to determine the effectiveness of MI for functional recovery after stroke and to identify a possible intervention protocol, according to the level of existing scientific evidence.Methods: A comprehensive literature search was performed using Medline, Cochrane Library and PEDro databases. Studies were limited to those published between 2007 and 2017, and restricted to English and/or Spanish language publications.Results: Thirteen randomized clinical trials that met the inclusion criteria were included. The methodological quality of studies was determined using the Critical Review Form for Quantitative Studies, obtaining scores of 9-13 points out of 15. The level of evidence and strength of recommendations were assessed using the U.S. Preventive Services Task Force (USPSTF) assessment, obtaining levels IA and II-B1. Significant improvements were found in outcome measures evaluating upper limb functionality, balance and kinematic gait parameters.Conclusions: The use of MI combined with conventional rehabilitation is an effective method for the recovery of functionality after stroke. Due to the great heterogeneity in the scientific literature available, new lines of research are necessary, in order to include well-designed studies of good methodological quality and to establish a consensus regarding the most appropriate protocols.

Resumen: Actualmente, el ictus representa un problema grave en la población, por lo que es necesario emplear técnicas de evaluación de diagnóstico y pronóstico más fiables y objetivas que permitan una eficaz toma de decisiones clínicas. La electroencefalografía es una herramienta sencilla, de bajo coste y no invasiva, que puede proporcionar conocimiento acerca de los cambios que acontecen en el córtex cerebral en el proceso de recuperación tras un ictus. Proporciona datos de evolución de los patrones de activación corticales, que permiten establecer un pronóstico para aprovechar el máximo potencial de las personas evitando compensaciones y plasticidad maladaptativa, redireccionar los tratamientos y desarrollar nuevas intervenciones con el objetivo de alcanzar el nuevo máximo nivel motor de los pacientes que han sufrido un ictus. Abstract: Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels. Palabras clave: Ictus, Electroencefalografía, Desincronización relacionada con eventos, Sincronización relacionada con eventos, Potenciales corticales relacionados con el movimiento, Plasticidad, Keywords: Stroke, Electroencephalography, Event-related desynchronisation, Event-related synchronisation, Movement-related cortical potentials, Plasticity

Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels. Resumen: Actualmente, el ictus representa un problema grave en la población, por lo que es necesario emplear técnicas de evaluación de diagnóstico y pronóstico más fiables y objetivas que permitan una eficaz toma de decisiones clínicas. La electroencefalografía es una herramienta sencilla, de bajo coste y no invasiva, que puede proporcionar conocimiento acerca de los cambios que acontecen en el córtex cerebral en el proceso de recuperación tras un ictus. Proporciona datos de evolución de los patrones de activación corticales, que permiten establecer un pronóstico para aprovechar el máximo potencial de las personas evitando compensaciones y plasticidad maladaptativa, redireccionar los tratamientos y desarrollar nuevas intervenciones con el objetivo de alcanzar el nuevo máximo nivel motor de los pacientes que han sufrido un ictus. Keywords: Stroke, Electroencephalography, Event-related desynchronisation, Event-related synchronisation, Movement-related cortical potentials, Plasticity, Palabras clave: Ictus, Electroencefalografía, Desincronización relacionada con eventos, Sincronización relacionada con eventos, Potenciales corticales relacionados con el movimiento, Plasticidad

Background Non-immersive video games are currently being used as technological rehabilitation tools for individuals with Parkinson’s disease (PD). The aim of this feasibility study was to evaluate the effectiveness of the Leap Motion Controller® (LMC) system used with serious games designed for the upper limb (UL), as well as the levels of satisfaction and compliance among patients in mild-to-moderate stages of the disease. Methods A non-probabilistic sampling of non-consecutive cases was performed. 23 PD patients, in stages II-IV of the Hoehn & Yahr scale, were randomized into two groups: an experimental group (n = 12) who received treatment based on serious games designed by the research team using the LMC system for the UL, and a control group (n = 11) who received a specific intervention for the UL. Grip muscle strength, coordination, speed of movements, fine and gross UL dexterity, as well as satisfaction and compliance, were assessed in both groups pre-treatment and post-treatment. Results Within the experimental group, significant improvements were observed in all post-treatment assessments, except for Box and Blocks test for the less affected side. Clinical improvements were observed for all assessments in the control group. Statistical intergroup analysis showed significant improvements in coordination, speed of movements and fine motor dexterity scores on the more affected side of patients in the experimental group. Conclusions The LMC system and the serious games designed may be a feasible rehabilitation tool for the improvement of coordination, speed of movements and fine UL dexterity in PD patients. Further studies are needed to confirm these preliminary findings.

This paper presents a preliminary study on the effectiveness of using a virtual environment for automation of the Fugl-Meyer Assessment (FMA) scoring. Also, a study of the feasibility of introducing a smoothness parameter to improve the scoring is described. A Kinect-based virtual environment was used for data acquisition and to enable a friendly method for the test administration. Movement smoothness was analyzed using the Spectral Arc length (SPARC).

[Background] The association between motor-related cortical activity and peripheral stimulation with temporal precision has been proposed as a possible intervention to facilitate cortico-muscular pathways and thereby improve motor rehabilitation after stroke. Previous studies with patients have provided evidence of the possibility to implement brain-machine interface platforms able to decode motor intentions and use this information to trigger afferent stimulation and movement assistance. This study tests the use a low-latency movement intention detector to drive functional electrical stimulation assisting upper-limb reaching movements of patients with stroke.Methods: An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention.Results: On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol.Conclusions: According to results obtained here with a small sample of patients, Brain-Machine Interfaces providing low-latency support to upper-limb reaching movements in patients with stroke are a reliable and usable solution for motor rehabilitation interventions with potential functional benefits., [Methods] An eight-sessions intervention on the paretic arm was tested on four chronic stroke patients along 1 month. Patients' intentions to initiate reaching movements were decoded from electroencephalographic signals and used to trigger functional electrical stimulation that in turn assisted patients to do the task. The analysis of the patients' ability to interact with the intervention platform, the assessment of changes in patients' clinical scales and of the system usability and the kinematic analysis of the reaching movements before and after the intervention period were carried to study the potential impact of the intervention., [Results] On average 66.3 ± 15.7% of trials (resting intervals followed by self-initiated movements) were correctly classified with the decoder of motor intentions. The average detection latency (with respect to the movement onsets estimated with gyroscopes) was 112 ± 278 ms. The Fügl-Meyer index upper extremity increased 11.5 ± 5.5 points with the intervention. The stroke impact scale also increased. In line with changes in clinical scales, kinematics of reaching movements showed a trend toward lower compensatory mechanisms. Patients' assessment of the therapy reflected their acceptance of the proposed intervention protocol., [Conclusions] According to results obtained here with a small sample of patients, Brain-Machine Interfaces providing low-latency support to upper-limb reaching movements in patients with stroke are a reliable and usable solution for motor rehabilitation interventions with potential functional benefits., This research has been supported by Spanish Ministry of Science project HYPER-CSD2009-00067. We acknowledge support of the publication fee by the CSIC Open Access Publication Support Initiative through its Unit of Information Resources for Research (URICI).

Coupling motor intentions decoded from cortical activities with coherent proprioceptive feedback is of interest for the motor rehabilitation of neurological patients with lesions in the central nervous system. For these interventions to be effective, repeated sessions need to be carried out to achieve functional long-lasting plastic changes of cortical circuits. Electroencephalography-based Brain-Computer Interfaces typically show significant decreases in accuracy when used across multiple sessions with fixed parameters. Therefore, it is important to look for optimal strategies to recalibrate these classifiers. Here we compare different recalibration strategies for systems decoding motor intentions based on electroencephalographic data of neurological patients.

Stroke motor rehabilitation strategies using neuromodulation paradigms that take advantage of the motor predictive characteristics of the electroencephalographic signal are currently subject to extensive research. Such rehabilitation strategies follow a top-down approach, in which targeted neurophysiological changes in the central nervous system are expected to induce functional improvement. This chapter presents a series of studies regarding processing algorithms to detect motor intentionality and a neuromodulation paradigm to improve the upper-limb functionality. The experiments were developed and tested with stroke patients.

Note: As originally published there ares errors in this document. The author names were presented as "J. Ibanez, J.I. Serrano, M.D. del Castillo, E. Monge, F. Molina, F.M. Rivas, I. Alguacil, J.C. Miangolarra and J.L. Pons" but were instead intended to be: "E. Monge-Pereira, F. Molina-Rueda, F. Rivas-Montero, I. Alguacil-Diego, and J.C. Miangolarra-Page" as noted here. The article PDF remains as originally published., This study proposes an intervention for stroke patients in which electrical stimulation of muscles in the affected arm is supplied when movement intention is detected from the electroencephalographic signal. The detection relies on the combined analysis of two movement related cortical patterns: the event-related desynchronization and the bereitschaftspotential. Results with two healthy subjects and three chronic stroke patients show that reliable EEG-based estimations of the movement onsets can be generated (on average, 66.9 % (std: 26.4) of the movements are detected with 0.42 (std: 0.17) false activations per minute) which in turn give rise to electrical stimuli providing sensory feedback tightly associated to the movement planning (average detection latency of the onsets of the movements was 54.4 (std: 287.9 ms)).

The electroencephalographic activity allows the characterization of movement-related cortical processes. This information may lead to novel rehabilitation technologies with the patients’ cortical activity taking an active role during the intervention. For such applications, the reliability of the estimations based on the electroencephalographic activity is critical both in terms of specificity and temporal accuracy. In this study, a detector of the onset of voluntary upper-limb reaching movements based on cortical rhythms and slow cortical potentials is proposed. To that end, upper-limb movements and cortical activity were recorded while participants performed self-paced movements. A logistic regression combined the output of two classifiers: a) a naive Bayes trained to detect the event-related desynchronization at the movement onset, and b) a matched filter detecting the bereitschaftspotential. On average, 74.5±10.8 % of the movements were detected and 1.32 ± 0.87 false detections were generated per minute. The detections were performed with an average latency of -89.9 ± 349.2 ms with respect to the actual movements. Therefore, the combination of two different sources of information (event-related desynchronization and bereitschaftspotential) is proposed as a way to boost the performance of this kind of systems.

Several studies have shown that both virtual and augmented reality are technologies suitable for rehabilitation therapy due to the inherent ability of simulating real daily life activities while improving patient motivation. In this paper we will first present the state of the art in the use of virtual and augmented reality applications for rehabilitation of motor disorders and second we will focus on the analysis of the results of our project. In particular, requirements of patients with cerebrovascular accidents, spinal cord injuries and cerebral palsy to the use of virtual and augmented reality systems will be detailed.

Introduction In the last years, new technologies such as the brain-machine interfaces (BMI) have been incorporated in the rehabilitation process of subjects with stroke. These systems are able to detect motion intention, analyzing the cortical signals using different techniques such as the electroencephalography (EEG). This information could guide different interfaces such as robotic devices, electrical stimulation or virtual reality. Case report A 40 years-old man with stroke with two months from the injury participated in this study. We used a BMI based on EEG. The subject's motion intention was analyzed calculating the event-related desynchronization. The upper limb motor function was evaluated with the Fugl-Meyer Assessment and the participant's satisfaction was evaluated using the QUEST 2.0. The intervention using a physical therapist as an interface was carried out without difficulty. Conclusions The BMI systems detect cortical changes in a subacute stroke subject. These changes are coherent with the evolution observed using the Fugl-Meyer Assessment.