scholarly journals Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation

2018 ◽  
Vol 119 (3) ◽  
pp. 1095-1112 ◽  
Author(s):  
Chelsea Kaupp ◽  
Gregory E. P. Pearcey ◽  
Taryn Klarner ◽  
Yao Sun ◽  
Hilary Cullen ◽  
...  
Keyword(s):  
Muscle Activation ◽  
Chronic Stroke ◽  
Reflex Modulation ◽  
Walking Ability ◽  
Functional Rehabilitation ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Interlimb Coupling ◽  
Before And After ◽  
Cycling Training

Training locomotor central pattern-generating networks (CPGs) through arm and leg cycling improves walking in chronic stroke. These outcomes are presumed to result from enhanced interlimb connectivity and CPG function. The extent to which rhythmic arm training activates interlimb CPG networks for locomotion remains unclear and was assessed by studying chronic stroke participants before and after 5 wk of arm cycling training. Strength was assessed bilaterally via maximal voluntary isometric contractions in the legs and hands. Muscle activation during arm cycling and transfer to treadmill walking were assessed in the more affected (MA) and less affected (LA) sides via surface electromyography. Changes to interlimb coupling during rhythmic movement were evaluated using modulation of cutaneous reflexes elicited by electrical stimulation of the superficial radial nerve at the wrist. Bilateral soleus stretch reflexes were elicited at rest and during 1-Hz arm cycling. Clinical function tests assessed walking, balance, and motor function. Results show significant changes in function and neurophysiological integrity. Training increased bilateral grip strength, force during MA plantarflexion, and muscle activation. “Normalization” of cutaneous reflex modulation was found during arm cycling. There was enhanced activity in the dorsiflexor muscles on the MA side during the swing phase of walking. Enhanced interlimb coupling was shown by increased modulation of MA soleus stretch reflex amplitudes during arm cycling after training. Clinical evaluations showed enhanced walking ability and balance. These results are consistent with training-induced changes in CPG function and interlimb connectivity and underscore the need for arm training in the functional rehabilitation of walking after neurotrauma.NEW & NOTEWORTHY It has been suggested but not tested that training the arms may influence rehabilitation of walking due to activation of interneuronal patterning networks after stroke. We show that arm cycling training improves strength, clinical function, coordination of muscle activity during walking, and neurological connectivity between the arms and the legs. The arms can, in fact, give the legs a helping hand in rehabilitation of walking after stroke.

scholarly journals Exploiting Interlimb Arm and Leg Connections for Walking Rehabilitation: A Training Intervention in Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-19 ◽  
Author(s):  
Taryn Klarner ◽  
Trevor S. Barss ◽  
Yao Sun ◽  
Chelsea Kaupp ◽  
Pamela M. Loadman ◽  
...  
Keyword(s):  
Neural Control ◽  
Cost Effective ◽  
Treadmill Walking ◽  
Reflex Modulation ◽  
Walking Ability ◽  
Cutaneous Reflex ◽  
Walking Rehabilitation ◽  
Increased Strength ◽  
Stride Duration ◽  
Cycling Training

Rhythmic arm and leg (A&L) movements share common elements of neural control. The extent to which A&L cycling training can lead to training adaptations which transfer to improved walking function remains untested. The purpose of this study was to test the efficacy of A&L cycling training as a modality to improve locomotor function after stroke. Nineteen chronic stroke (>six months) participants were recruited and performed 30 minutes of A&L cycling training three times a week for five weeks. Changes in walking function were assessed with (1) clinical tests; (2) strength during isometric contractions; and (3) treadmill walking performance and cutaneous reflex modulation. A multiple baseline (3 pretests) within-subject control design was used. Data show that A&L cycling training improved clinical walking status increased strength by ~25%, improved modulation of muscle activity by ~25%, increased range of motion by ~20%, decreased stride duration, increased frequency, and improved modulation of cutaneous reflexes during treadmill walking. On most variables, the majority of participants showed a significant improvement in walking ability. These results suggest that exploiting arm and leg connections with A&L cycling training, an accessible and cost-effective training modality, could be used to improve walking ability after stroke.

scholarly journals Muscle Electrical Impedance Properties and Activation Alteration After Functional Electrical Stimulation-Assisted Cycling Training for Chronic Stroke Survivors: A Longitudinal Pilot Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Chengpeng Hu ◽  
Tong Wang ◽  
Kenry W. C. Leung ◽  
Le Li ◽  
Raymond Kai-Yu Tong
Keyword(s):  
Electrical Stimulation ◽  
Lower Extremity ◽  
Functional Electrical Stimulation ◽  
Electrical Impedance ◽  
Muscle Activation ◽  
Chronic Stroke ◽  
Anisotropy Ratio ◽  
Stroke Survivors ◽  
Clinical Scales ◽  
Cycling Training

Electrical impedance myography (EIM) is a sensitive assessment for neuromuscular diseases to detect muscle inherent properties, whereas surface electromyography (sEMG) is a common technique for monitoring muscle activation. However, the application of EIM in detecting training effects on stroke survivors is relatively few. This study aimed to evaluate the muscle inherent properties and muscle activation alteration after functional electrical stimulation (FES)-assisted cycling training to chronic stroke survivors. Fifteen people with chronic stroke were recruited for 20 sessions of FES-assisted cycling training (40 min/session, 3–5 sessions/week). The periodically stimulated and assessed muscle groups were quadriceps (QC), tibialis anterior (TA), hamstrings (HS), and medial head of gastrocnemius (MG) on the paretic lower extremity. EIM parameters [resistance (R), reactance (X), phase angle (θ), and anisotropy ratio (AR)], clinical scales (Fugl-Meyer Lower Extremity (FMA-LE), Berg Balance Scale (BBS), and 6-min walking test (6MWT)] and sEMG parameters [including root-mean square (RMS) and co-contraction index (CI) value] were collected and computed before and after the training. Linear correlation analysis was conducted between EIM and clinical scales as well as between sEMG and clinical scales. The results showed that motor function of the lower extremity, balance, and walking performance of subjects improved after the training. After training, θ value of TA (P = 0.014) and MG (P = 0.017) significantly increased, and AR of X (P = 0.004) value and AR of θ value (P = 0.041) significantly increased on TA. The RMS value of TA decreased (P = 0.022) and a significant reduction of CI was revealed on TA/MG muscle pair (P < 0.001). Significant correlation was found between EIM and clinical assessments (AR of X value of TA and FMA-LE: r = 0.54, P = 0.046; X value of TA and BBS score: 0.628, P = 0.016), and between sEMG and clinical scores (RMS of TA and BBS score: r = −0.582, P = 0.029). This study demonstrated that FES-assisted cycling training improved lower limb function by developing coordinated muscle activation and facilitating an orderly myofiber arrangement. The current study also indicated that EIM can jointly evaluate lower extremity function alteration with sEMG after rehabilitation training.Clinical Trail Registration: The study was registered on the Clinical Trial Registry (trial registration number: NCT 03208439, https://clinicaltrials.gov/ct2/show/NCT03208439).

Prior experience does not alter modulation of cutaneous reflexes during manual wheeling and symmetrical arm cycling

2013 ◽  
Vol 109 (9) ◽  
pp. 2345-2353 ◽  
Author(s):  
Megan K. MacGillivray ◽  
Marc Klimstra ◽  
Bonita Sawatzky ◽  
E. Paul Zehr ◽  
Tania Lam
Keyword(s):  
Amplitude Modulation ◽  
Reflex Response ◽  
Reflex Modulation ◽  
Cutaneous Reflexes ◽  
Triceps Brachii ◽  
Reflex Amplitude ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Cyclic Movements ◽  
Middle Latency

Previous research has reported that training and experience influence H-reflex amplitude during rhythmic activity; however, little research has yet examined the influence of training on cutaneous reflexes. Manual wheelchair users (MWUs) depend on their arms for locomotion. We postulated that the daily dependence and high amount of use of the arms for mobility in MWUs would show differences in cutaneous reflex modulation during upper limb cyclic movements compared with able-bodied control subjects. We hypothesized that MWUs would demonstrate increased reflex response amplitudes for both manual wheeling and symmetrical arm cycling tasks. The superficial radial nerve was stimulated randomly at different points of the movement cycle of manual wheeling and symmetrical arm cycling in MWUs and able-bodied subjects naive to wheeling. Our results showed that there were no differences in amplitude modulation of early- or middle-latency cutaneous reflexes between the able-bodied group and the MWU group. However, there were several differences in amplitude modulation of cutaneous reflexes between tasks (manual wheeling and symmetrical arm cycling). Specifically, differences were observed in early-latency responses in the anterior and posterior deltoid muscles and biceps and triceps brachii as well as in middle-latency responses in the anterior and posterior deltoid. These data suggest that manual wheeling experience does not modify the pattern of cutaneous reflex amplitude modulation during manual wheeling. The differences in amplitude modulation of cutaneous reflexes between tasks may be a result of mechanical differences (i.e., hand contact) between tasks.

scholarly journals Neural control of rhythmic arm cycling after stroke

2012 ◽  
Vol 108 (3) ◽  
pp. 891-905 ◽  
Author(s):  
E. Paul Zehr ◽  
Pamela M. Loadman ◽  
Sandra R. Hundza
Keyword(s):  
Neural Control ◽  
Arm Movement ◽  
Constant Current ◽  
Cycle Phase ◽  
Emg Activity ◽  
Reflex Modulation ◽  
Cutaneous Reflexes ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Modulation Pattern

Disordered reflex activity and alterations in the neural control of walking have been observed after stroke. In addition to impairments in leg movement that affect locomotor ability after stroke, significant impairments are also seen in the arms. Altered neural control in the upper limb can often lead to altered tone and spasticity resulting in impaired coordination and flexion contractures. We sought to address the extent to which the neural control of movement is disordered after stroke by examining the modulation pattern of cutaneous reflexes in arm muscles during arm cycling. Twenty-five stroke participants who were at least 6 mo postinfarction and clinically stable, performed rhythmic arm cycling while cutaneous reflexes were evoked with trains (5 × 1.0-ms pulses at 300 Hz) of constant-current electrical stimulation to the superficial radial (SR) nerve at the wrist. Both the more (MA) and less affected (LA) arms were stimulated in separate trials. Bilateral electromyography (EMG) activity was recorded from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on averaged reflexes in 12 equidistant phases of the movement cycle. Phase-modulated cutaneous reflexes were present, but altered, in both MA and LA arms after stroke. Notably, the pattern was “blunted” in the MA arm in stroke compared with control participants. Differences between stroke and control were progressively more evident moving from shoulder to wrist. The results suggest that a reduced pattern of cutaneous reflex modulation persists during rhythmic arm movement after stroke. The overall implication of this result is that the putative spinal contributions to rhythmic human arm movement remain accessible after stroke, which has translational implications for rehabilitation.

Forward and Backward Arm Cycling Are Regulated by Equivalent Neural Mechanisms

2005 ◽  
Vol 93 (1) ◽  
pp. 633-640 ◽  
Author(s):  
E. Paul Zehr ◽  
Sandra R. Hundza
Keyword(s):  
Neural Control ◽  
Arm Movement ◽  
Movement Direction ◽  
Reflex Modulation ◽  
Neural Activation ◽  
Cutaneous Reflexes ◽  
Leg Muscles ◽  
Cutaneous Reflex ◽  
Arm Cycling ◽  
Walking Activity

It was shown some time ago that cutaneous reflexes were phase-reversed when comparing forward and backward treadmill walking. Activity of central-pattern-generating networks (CPG) regulating neural activity for locomotion was suggested as a mechanism involved in this “program reversal.” We have been investigating the neural control of arm movements and the role for CPG mechanisms in regulating rhythmic arm cycling. The purpose of this study was to evaluate the pattern of muscle activity and reflex modulation when comparing forward and backward arm cycling. During rhythmic arm cycling (forward and backward), cutaneous reflexes were evoked with trains (5 × 1.0 ms pulses at 300 Hz) of electrical stimulation delivered to the superficial radial (SR) nerve at the wrist. Electromyographic (EMG) recordings were made bilaterally from muscles acting at the shoulder, elbow, and wrist. Analysis was conducted on specific sections of the movement cycle after phase-averaging contingent on the timing of stimulation in the movement cycle. EMG patterns for rhythmic arm cycling are similar during both forward and backward motion. Cutaneous reflex amplitudes were similarly modulated at both early and middle latency irrespective of arm cycling direction. That is, at similar phases in the movement cycle, responses of corresponding sign and amplitude were seen regardless of movement direction. The results are generally parallel to the observations seen in leg muscles after stimulation of cutaneous nerves in the foot during forward and backward walking and provide further evidence for CPG activity contributing to neural activation and reflex modulation during rhythmic arm movement.

scholarly journals MRI Evaluation of Patella Alignment Before and After Anatomical Reconstruction of ACL Undergoing Unified Rehabilitation Programme Introduced by CMC Physical Therapy Team

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0014
Author(s):  
Dariusz Straszewski ◽  
Marcin Plenzler ◽  
Joanna Szczepaniak ◽  
Robert Śmigielski ◽  
Beata Ciszkowska-Łysoń ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Muscle Activation ◽  
Weight Bearing ◽  
Tendon Graft ◽  
Rehabilitation Programme ◽  
Anatomical Reconstruction ◽  
Patella Baja ◽  
Functional Rehabilitation ◽  
Patellar Tendon Graft ◽  
The Impact

Objectives: The aim of the study was to asses the impact of the functional rehabilitation on patella alignment with MRI imaging in patients who underwent the ACL reconstruction. The surgical approach with the use of patellar tendon graft is known to carry the risk of lowering patella height (patella baja), which, in turn, may lead to accelerated cartilage wear in patellofemoral joint. Methods: 30 patients after the anatomical reconstruction of ACL took part in this study (23 male, and 7 female, mean age = 28 ± 10,6 years). During the procedure a patellar tendon graft was used. The Insali-Salvati ratio measured with MRI (images taken pre-procedural, and 9 months after the surgery) was used for the assessment of patellar alignment. The measurements were taken by one radiology specialist on MRI scans in sagittal view in PD sequence. During the examination, patellar joint was in flexion (approx.10 degrees). As the point of reference for patella’s position ISR ratio was in the range of 0.8 - 1.2. All patients were operated on by the same team of surgeons and underwent an unified rehabilitation programme led by a team of selected physiotherapists. The main features of the programme were: an early muscle activation (second day after the procedure); mobilisation of the patella and tissues of the anterior compartment of the knee; weight bearing co-contraction exercises, and the sensomotoric training of the entire kinetic chain of the lower limb. The data recorded was statistically analysed using the Wilcoxon signed-rank test in order to establish parameters’ changes within the study group.. Results: The mean ISR value before the procedure was 0.84 (± 0,1), whereas 9 months after the surgery it was 0.85 (± 0,1). The results’ analysis did not show any statistically significant changes between ISR values. Nine months after the procedure patella baja has not been observed in any of the evaluated patients. Conclusion: The functional rehabilitation programme designed by the CMC team had no negative impact on patella alignment, as no patella baja, which is a common complication after these kinds of surgeries, has been observed. The applied functional rehabilitation programme enabled patients to keep the proper patella alignment, similar to the alignment recorded before the surgery.

Minimal clinically important difference of the 6-min walking test in patients with asthma

2021 ◽  
Vol 25 (3) ◽  
pp. 215-221
Author(s):  
E. Zampogna ◽  
N. Ambrosino ◽  
R. Centis ◽  
F. Cherubino ◽  
G. B. Migliori ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Operating Characteristic ◽  
Minimal Clinically Important Difference ◽  
Walking Ability ◽  
Walking Test ◽  
Receiver Operating Characteristic Curves ◽  
Clinically Important Difference ◽  
Copd Assessment Test ◽  
Before And After ◽  
Perceived Change

BACKGROUND: The 6‐min walking test (6MWT) is responsive to physiological changes and pulmonary rehabilitation (PR) in patients with asthma. The minimal clinically important difference (MCID) has not been established yet.OBJECTIVE: To determine the MCID of 6MWT in patients with asthma.METHODS: Using the perceived change in walking ability and the modified Medical Research Council (mMRC) score as anchors, receiver operating characteristic curves and quantile regression, we evaluated 6MWT before and after PR in these patients. The St George Respiratory Questionnaire (SGRQ), the COPD assessment test (CAT) and other outcome measures were also assessed.RESULTS: Of 142 patients with asthma, 37 were enrolled. After PR, 6MWT increased from 453.4 m ± 88.8 to 493.0 m ± 97.2 (P = 0.0001); other outcome measures also increased. There was a slight correlation between baseline 6MWT and SGRQ, CAT and mMRC. No significant correlations were found between post‐PR changes in 6MWT and in other outcome measures. Comparing different methods of assessment, the MCID ranged from 26 m to 27 m.CONCLUSION: The most conservative estimate of the MCID of 6MWT after PR was 26 m in patients with asthma. This estimate may be useful in clinical interpretation of data, particularly in response to intervention studies.

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