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Abstract: Hunter SM, Crome P, Sim J, Pomeroy VM. Effects of mobilization and tactile stimulation on recovery of the hemiplegic upper limb: a series of replicated single-system studies. Objective: To explore the effects on motor function and impairment of mobilization and tactile stimulation for the paretic arm and hand after stroke. Design: Replicated single-system series, ABA design. Setting: The stroke rehabilitation ward of a community hospital in the United Kingdom. Participants: Consecutive sample, men and women (N=6) with stroke (left or right), within 3 months of onset. Intervention: Sixty minutes of daily mobilization and tactile stimulation to the paretic arm and hand for 6 weeks in addition to the usual rehabilitation program. Main Outcome Measures: Focal disability (Action Research Arm Test [ARAT]) and motor impairment (Motricity Index arm section). Results: All participants showed visual change in 1 or more of trend, level, or slope between baseline and intervention phases for both the ARAT and the Motricity Index. The visual analysis was confirmed through statistical testing (c statistic and/or Mann-Whitney U test) for 5 of 6 participants (statistical analysis was precluded for 1 participant). No further improvements were made on intervention withdrawal. Conclusions: This study shows proof of concept for using mobilization and tactile stimulation to improve motor recovery after severe paresis, justifying conducting dose-finding studies as a precursor to multicenter phase III clinical trials. [Copyright &y& Elsevier]

This study investigated the feasibility of the uncontrolled manifold approach (UCM) to analyse gait data variability in relation to the control of the centre of mass (COM) in adults with and without neuropathology. The proposed method was applied to six able-bodied subjects to characterise mechanisms of normal postural control during stance phase. This approach was repeated on an early stroke patient, who attended the laboratory three times at three monthly intervals, to characterise the variability of COM movement during walking with and without an orthosis. Both able-bodied subjects and the stroke participant controlled COM movement during stance but utilized a different combination of lower limb joint kinematics to ensure that the COM trajectory was not compromised. Interestingly, the stroke subject, despite a higher variability in joint kinematics, was able to maintain a stable COM position throughout stance phase. The stabilisation of the COM decreased when the patient walked unaided without the prescribed orthosis but increased over the six months of study. The UCM analysis demonstrated how a stroke patient used a range of lower limb motion pattern to stabilise the COM trajectory. It is suggested that this analysis can be used to track changes in these movement patterns in response to rehabilitation. As such we propose that this approach could have clinical utility to evaluate and prescribe rehabilitation in stroke patients. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to investigate the clinical potential of an augmented-video-based-portable-system (AVPS). The AVPS included a walkway grid mat made of vinyl flooring, flat paper bull's eye markers, four photoswitches mounted on tripods, a light-indicator, a video camera, and a computer with ProTrainer System software. The AVPS output was compared to a “gold standard” 3D Vicon Motion Analysis System both statically and dynamically over a fixed range (−90° to +90°) using a two-segment-goniometric-rig marked with both bull's eye and retroreflective markers. At each segment angle position, three trials of data were captured. The reliability of the AVPS was also tested using three raters. Further twelve, young, healthy subjects participated in a concurrent validity study in which they performed six gait trials which were simultaneously recorded by both systems. Both motion analysis systems showed low levels of intra subject variability in all kinematic variables indicated by the size of the standard deviations across the six trials. There were no significant differences between the motion systems with respect to the kinematic variables (P >0.05). The results showed a high intra- and inter-rater reliability for both the kinematic and temporo-spatial parameters. With respect to gait events the lowest ICC value for the intra-rater reliability test was 0.993 for the kinematic variables, and ranged from 0.941 to 0.956 for the temporo-spatial variables and 0.731 to 0.954 for the tibia inclination angles. The validation data suggest the AVPS is capable of generating highly reliable and repeatable data when applied to normal subjects and could be used within the clinical setting. [Copyright &y& Elsevier]