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A previously healthy 6-year-old boy was brought to the emergency department with a sudden inability to walk or bear weight on his legs. Four days earlier, he had experienced a fever and runny nose and was given symptomatic treatment with simple analgesics at home. For the next two days, he had more...

This paper presents a novel, smart and portable active knee rehabilitation orthotic device (AKROD) designed to train stroke patients to correct knee hyperextension during stance and stiff-legged gait (defined as reduced knee flexion during swing). The knee brace provides variable damping controlled in ways that foster motor recovery in stroke patients. A resistive, variable damper, electro-rheological fluid (ERF) based component is used to facilitate knee flexion during stance by providing resistance to knee buckling. Furthermore, the knee brace is used to assist in knee control during swing, i.e. to allow patients to achieve adequate knee flexion for toe clearance and adequate knee extension in preparation to heel strike. The detailed design of AKROD, the first prototype built, closed loop control results and initial human testing are presented here more...

Objective: The authors previously suggested that spastic paretic stiff-legged gait, defined as reduced knee flexion in swing associated with upper-motor neuron injury, can be attributed to multiple impairments besides spastic quadriceps activity. This study hypothesizes that subjects with spastic paretic stiff-legged gait have altered kinetics not only about the knee but also about the hip and ankle. Design: Joint kinetic data of 20 subjects with spastic paretic stiff-legged gait caused by stroke were compared with data obtained from 20 able-bodied subjects. Results: Significant reductions in the subject group were found in both peak knee-joint power absorption (0.42 ± 0.34 vs. 0.99 ± 0.27 W/(kg.m.m/sec)) and peak ankle-joint power generation (0.74 ± 0.42 vs. 1.51 ± 0.17 W/(kg.m.m/sec); both P < 0.0001). The authors observed increases in peak external-hip flexion torque in stance, hip-power generation in loading response, knee-extension torque in midstance, ankle-dorsiflexion torque, and ankle-power absorption in stance. There was substantial variability in most torque and power values among subjects, which was significantly greater than that observed in the control subjects. Conclusions: These findings, in conjunction with previous studies, support the likelihood of multiple mechanisms for reduced knee flexion in swing. Alternatively, some of the joint kinetic differences could be compensations for or associated with reduced knee flexion in swing. The substantial variability among subjects implies that despite a similar visual appearance of reduced knee flexion among subjects with a spastic paretic stiff-legged gait pattern, each individual has unique mechanisms associated with this observed gait pattern. more...

O ctober 2001: Botulinum Toxin. Injected Muscles: Right Soleus, Medial and Lateral Gastrocnemius; N ovember 2001: surgical treatment Selective Neurotomy of Tibial Nerve; M ay 2002: surgical treatment di Flexor Digitorum Tenotomy and transfer on Os-calcis; S eptember 2004: surgical treatment Rectus Femoral Transfer [3] and Extensor hallucis Transfer pro dorsiflexor; J anuary 2006: specific exercises to improve strength and control of hip flexor muscles. more...

Selective tenotomy of one or two heads of the quadriceps based on electromyographic criteria improved knee flexion in hemiplegic patients who walked with a unilateral stiff-legged gait. The improvement was greatest in eight patients in whom the rectus femoris was released, either with or without release of the vastus intermedius, with activity in pre-swing stance and initial swing confined to those heads of the quadriceps; in these patients knee flexion improved an average of 20 degrees. Knee flexion improved an average of only 8 degrees in five patients in who activity was present in one head of the quadriceps that was not surgically released. No improvement in knee flexion occurred in seven of eight patients in whom activity was present in two or more of the quadriceps heads that were not surgically released. more...