Abstract TP156: Robot-Guided Ankle and Knee Therapeutic Training Improves Motor Functions in Stroke

Introduction: Stroke survivors develop substantial disability such as weakness, spasticity, increased stiffness, and reduced range of motion in lower limbs, contributing to reduced quality of life. It is important to stretch impaired ankle and knee to increase range of motion and reduce spasticity, and to conduct active movement training to improve balance and locomotion. Hypothesis: We addressed the hypotheses that robot-aided ankle and knee training will reduce motor impairments and improve balance and gait functions, and the improvements will maintain to the 6-weeks follow-up. Methods: Seven male stroke survivors participated in the robot-guided ankle and knee rehabilitation training using a pair of ankle and knee rehabilitation robots over 18 training sessions (3 sessions/week for 6 weeks). Three evaluations were done before and after training, and 6 weeks follow-up. Each session involved passive stretching under intelligent control and active movement training under real-time, audiovisual and haptic feedback. About equal time was spent on the ankle and knee training. Results: We found significant improvement in 6-Minute Walk Test (6MWT: 294.8 m pre-training to 386.4 m post training; p<0.01), Berg Balance Scale (BBS, 45 pre to 52 post; p<0.05), ankle active range of motion (AROM) (-11.7° pre to 1.7° post; p<0.05, a negative value means not being able to reach 0° dorsiflexion), passive ROM in dorsiflexion (12.7° pre to 23.3° post; p<0.01), and dorsiflexion muscle strength (-0.3 Nm pre to 5.7 Nm post; p<0.05, negative means lower than the passive torque at 0° ankle dorsiflexion). The knee had significant improvement in AROM in extension against the load of the robot (34.8° pre to 15.9° knee flexion post; p<0.05) and maximal flexion strength at 90° knee flexion (19.3 Nm pre to 31.7 Nm post; p<0.01). At the follow-up, the outcomes were found as similar results of post evaluation, e.g., 379m (p<0.05) in 6MWT, 51 (p<0.05) in BBS, and 5.2 Nm (p=0.05) in dorsiflexion strength. Conclusions: In conclusions, robot-guided stretching and active movement training reduced impairments at the knee and ankle of stroke survivors resulting in improved mobility. Furthermore, the effect of training was maintained at the 6-weeks follow-up after the treatment.

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Assessing Stiffness, Joint Torque and ROM for Paretic and Non-Paretic Lower Limbs during the Subacute Phase of Stroke Using Lokomat Tools

Applied Sciences ◽

10.3390/app10186168 ◽

2020 ◽

Vol 10 (18) ◽

pp. 6168

Author(s):

Betsy D. M. Chaparro-Rico ◽

Daniele Cafolla ◽

Paolo Tortola ◽

Giuseppe Galardi

Keyword(s):

Observational Study ◽

Range Of Motion ◽

Lower Limb ◽

Significant Trend ◽

Lower Limbs ◽

Joint Torque ◽

Retrospective Observational Study ◽

Stroke Patients ◽

Subacute Phase

The efficacy of Lokomat on motor recovery in stroke patients is well known. However, few studies have examined Lokomat tools to assess stiffness, joint torque and range of motion (ROM) during the subacute phase of stroke. The purpose of this retrospective observational study is to assess the changes of joint torque, ROM and stiffness that were estimated with Lokomat tools, namely L-FORCE (lower limb-force), L-ROM (lower limb-range of motion)and L-STIFF (lower limb-stiff), for paretic and non-paretic lower limbs in the subacute phase of stroke, assuming that the tools were able to measure these changes. The data come from 10 subjects in the subacute phase who had their first ever-stroke and followed a treatment that included Lokomat. The measurements came from basal assessments (T0) and one-month follow-up (T1). The measures were compared between paretic and non-paretic legs, and between T0 and T1. Significant differences in stiffness, joint torque and ROM were obtained between the paretic and non-paretic limbs at both T0 and T1. A non-significant trend was obtained for reduced stiffness and increased torque and ROM between T0 and T1 of the paretic limbs. The Lokomat tools were able to measure the changes between paretic and non-paretic legs and the small changes between T0 and T1 measurements.

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Abstract W MP57: Effects of Wearable Robotic Training of Ankle and Mobility Rehabilitation in Acute Stroke

Stroke ◽

10.1161/str.46.suppl_1.wmp57 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Kai Chen ◽

Yupeng Ren ◽

Richard L Harvey ◽

Elliot J Roth ◽

Li-Qun Zhang

Keyword(s):

Acute Stroke ◽

Outcome Measures ◽

Neural Plasticity ◽

Repeated Measures ◽

Small Sample ◽

Lower Limbs ◽

Control Group ◽

Active Movement ◽

Robotic Training ◽

Movement Training

Background and Purpose: Stroke is the fourth leading cause of death in the US and is a leading cause of adult disability. It was reported that the first few months post stroke is critical in neural plasticity and motor recovery. Presently, effective treatment options for ankle impairment and mobility are limited, especially for in-bed acute stroke rehabilitation. In this study, wearable robotic training involving passive stretching and active movement training was investigated to determine its efficacy in improving stroke outcome. Methods: Eleven patients with acute stroke participated. This was completed in a clinical in-patient setting (45 min/session, 3~5х/week, total 18 session). Participants were aged 53.7±17.4 (mean±SD); robotic treatment was given averaged 40.5 days of stroke onset. They continued receiving standard inpatient physical therapy during the study. One way repeated measures ANOVA was used to compare clinical and biomechanical outcome measures across the repeated measures. Results: Preliminary results showed an improvement after the multiple sessions of training with F-M in LE increased from 14.8 ± 8.8 and 19.4 ± 8.2 (p<.01), STREAM score in LE from 32.1±21.4 to 47.9±30.1 (p=.02), the BBS increased from 35.2±17.8 to 38.0±18.2. Ankle active range of motion (AROM) in dorsiflexion increased from -5.7 ± 7.2° to 2.3 ± 8.1°(p=.004), ankle passive ROM in dorsiflexion from 14.0 ± 7.1° to 19.9 ± 5.3° (p=.002). Dorsiflexor strength increased from 0 ± 2.2 N m before training to 2.4 ±3.5 N m after training (p=.003). Plantarflexor strength increased from 6.7±9.9 Nm, to 12.6 ± 11.4 Nm (p=.004). Other measures showed no significant improvements, such as 6MWT increased from 302.0 ± 416.4 and 540.6 ± 563.4 feet, the MAS of ankle was 2.2 ± 1.1 to 1.6 ± 1.2. Conclusions: The use of robotic device demonstrated improvements in selected outcome measures in hospital settings, and it was efficiently administer in the clinic. The results suggest that impaired lower limbs of acute stroke can respond to controlled stretching and movement training in terms of muscle biomechanical properties and improve lower extremity functional activities in acute rehabilitation.The limitation of this study was its small sample size and lack of a control group.

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Monitoring and Assessment of Rehabilitation Progress on Range of Motion After Total Knee Replacement by Sensor-Based System

Sensors ◽

10.3390/s20061703 ◽

2020 ◽

Vol 20 (6) ◽

pp. 1703 ◽

Cited By ~ 1

Author(s):

Yo-Ping Huang ◽

Yu-Yu Liu ◽

Wei-Hsiu Hsu ◽

Li-Ju Lai ◽

Mel S. Lee

Keyword(s):

Total Knee Replacement ◽

Range Of Motion ◽

Knee Replacement ◽

Knee Flexion ◽

Triaxial Accelerometer ◽

Isokinetic Dynamometer ◽

Sensor Device ◽

Knee Rehabilitation ◽

Total Knee ◽

Swing Speed

For total knee replacement (TKR) patients, rehabilitation after the surgery is key to regaining mobility. This study proposes a sensor-based system for effectively monitoring rehabilitation progress after TKR. The system comprises a hardware module consisting of the triaxial accelerometer and gyroscope, a microcontroller, and a Bluetooth module, and a software app for monitoring the motion of the knee joint. Three indices, namely the number of swings, the maximum knee flexion angle, and the duration of practice each time, were used as metrics to measure the knee rehabilitation progress. The proposed sensor device has advantages such as usability without spatiotemporal constraints and accuracy in monitoring the rehabilitation progress. The performance of the proposed system was compared with the measured range of motion of the Cybex isokinetic dynamometer (or Cybex) professional rehabilitation equipment, and the results revealed that the average absolute errors of the measured angles were between 1.65° and 3.27° for the TKR subjects, depending on the swing speed. Experimental results verified that the proposed system is effective and comparable with the professional equipment.

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Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

The Journal of Knee Surgery ◽

10.1055/s-0040-1709675 ◽

2020 ◽

Author(s):

Jung-Won Lim ◽

Yong-Beom Park ◽

Dong-Hoon Lee ◽

Han-Jun Lee

Keyword(s):

Total Knee Arthroplasty ◽

Patient Satisfaction ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Knee Flexion ◽

Functional Score ◽

Manipulation Under Anesthesia ◽

Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report

Medical & Clinical Research ◽

10.33140/mcr.02.01.04 ◽

2017 ◽

Vol 2 (1) ◽

Keyword(s):

Case Report ◽

Congenital Syphilis ◽

Eosinophilic Granuloma ◽

Osteolytic Lesion ◽

Lower Limbs ◽

Upper Body ◽

Elective Cesarean Section ◽

Distal Fibula ◽

X Ray

Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.

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Electronic Moxibustion for Breast Cancer-Related Lymphedema: A Pilot Clinical Trial

Integrative Cancer Therapies ◽

10.1177/1534735420962854 ◽

2020 ◽

Vol 19 ◽

pp. 153473542096285

Author(s):

Kyungsun Han ◽

Ojin Kwon ◽

Hyo-Ju Park ◽

Ae-Ran Kim ◽

Boram Lee ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Range Of Motion ◽

Upper Limb ◽

Life Questionnaire ◽

Breast Cancer Patients ◽

Shoulder Range Of Motion ◽

Breast Cancer Related Lymphedema ◽

Shoulder Range

This is a preliminary study to investigate the feasibility of electronic moxibustion in breast cancer patients with upper limb lymphedema. As current treatment options for lymphedema are unsatisfactory and time consuming, there have been attempts to manage symptoms using integrative treatments. Electronic moxibustion was developed to compensate for the shortcomings of conventional moxibustion and is widely used in clinical practice. However, there have been no studies on using electronic moxibustion in breast cancer-related lymphedema. To investigate the feasibility of electronic moxibustion in treating breast cancer-related lymphedema, this study included subjects who completed primary cancer treatment at least 6 months ago and had more than 10 mm difference in arm circumference of upper limbs. All subjects were assigned to the treatment group. Subjects were treated with 16 sessions (30 minutes/session) of electronic moxibustion for 8 weeks followed by 4 weeks of follow-up. For outcome measures, upper limb circumferences, shoulder range of motion, bioimpedance analysis, and quality of life questionnaire were assessed. All 10 subjects completed the study. The effective index showed 38.21% reduction after treatment ( P = .0098) and 29.35% ( P = .0039) after 4 weeks of follow-up compared to the baseline. The reduction of lymphedema was most prominent at 10 cm above the elbow crease, where the mean reduction of circumference difference was 7.5 mm ( P = .0430) and continued to improve after treatment (mean reduction of 8.3 mm, P = .0156). There was significant improvement in shoulder range of motion only in flexion and internal rotation at week 9. There were 7 adverse events, and most were irrelevant to the treatment. Only 1 participant had a mild burn on the acupuncture point. Here, we demonstrate for the first time that electronic moxibustion treatment is a feasible treatment for breast cancer-related lymphedema. Electronic moxibustion may reduce differences in upper limb circumference and improve shoulder range of motion. A future comparative clinical trial is needed to confirm the clinical efficacy of this treatment.

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Effectiveness of arthroscopic management of idiopathic shoulder stiffness: A meta-analysis

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200267 ◽

2021 ◽

pp. 1-8

Author(s):

Ya-Dong Wang ◽

Yu-Xiang Ming ◽

Yong-Hua Pang ◽

Wei-Nan Chen ◽

Xu-Hua Zong ◽

...

Keyword(s):

Range Of Motion ◽

External Rotation ◽

Meta Analysis ◽

Eligibility Criteria ◽

Shoulder Stiffness ◽

Capsular Release ◽

Shoulder Range Of Motion ◽

Arthroscopic Capsular Release ◽

Shoulder Range

BACKGROUND: Persisting shoulder stiffness adversely affects quality of life by causing pain and motion restrictions especially in patients with diabetes. OBJECTIVE: The aim of this study was to evaluate the outcomes of arthroscopic capsular release in patients with idiopathic shoulder stiffness. METHOD: A literature search was conducted in electronic databases and studies were selected by following precise eligibility criteria. Random-effects meta-analyses were performed to estimate the changes at latest follow-up in scores of the Constant, American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angelis (UCLA) scales, Visual Analogue Scale (VAS), and shoulder range of motion. RESULTS: Nineteen studies were included. The follow-up duration was 42 months [95% confidence interval (CI): 32, 51]. Improvements in scores of the Constant, ASES, UCLA scales, and VAS were 48.3 [95% CI: 38.0, 58.6], 44.6 [95% CI: 24.6, 64.6], 19.3 [95% CI: 16.6, 22.0], and -6.1 [95% CI: -6.9, -5.4] respectively (P< 0.05 all). Improvements in the shoulder range of motion were: abduction 82.0 [95% CI: 65.0, 98.9]; forward flexion 75.9 [95% CI: 59.7, 92.1]; external rotation 43.2 [95% CI: 37.5, 49.0]; and internal rotation 25.4 [95% CI: 15.2, 35.5] degrees; P< 0.05 all). CONCLUSION: Arthroscopic capsular release effectively improves shoulder function in patients with idiopathic shoulder stiffness.

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Effects of posterior tibial slope on the mid-term results of medial unicompartmental knee arthroplasty

Arthroplasty ◽

10.1186/s42836-021-00070-y ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Zhijie Chen ◽

Kaizhe Chen ◽

Yufei Yan ◽

Jianmin Feng ◽

Yi Wang ◽

...

Keyword(s):

Knee Flexion ◽

Tibial Slope ◽

Posterior Tibial ◽

Significant Difference ◽

Medial Unicompartmental Knee Arthroplasty ◽

Group 3 ◽

Group 2 ◽

Postoperative Knee ◽

Group 1

Abstract Objective To evaluate the effect of medial posterior tibial slope (PTS) on mid-term postoperative range of motion (ROM) and functional improvement of the knee after medial unicompartmental knee arthroplasty (UKA). Methods Medical records of 113 patients who had undergone 124 medial UKAs between April 2009 through April 2014 were reviewed retrospectively. The mean follow-up lasted 7.6 years (range, 6.2–11.2 years). Collected were demographic data, including gender, age, height, weight of the patients. Anteroposterior (AP) and lateral knee radiographs of the operated knees were available in all patients. The knee function was evaluated during office follow-up or hospital stay. Meanwhile, postoperative PTS, ROM, maximal knee flexion and Hospital for Special Surgery (HSS) knee score (pre−/postoperative) of the operated side were measured and assessed. According to the size of the PTS, patients were divided into 3 groups: group 1 (<4°), group 2 (4° ~ 7°) and group 3 (>7°). The association between PTS and the knee function was investigated. Results In our cohort, the average PTS was 2.7° ± 0.6° in group 1, 5.6° ± 0.9° in group 2 and 8.7° ± 1.2° in group 3. Pairwise comparisons showed significant differences among them (p < 0.01). The average maximal flexion range of postoperative knees in each group was 112.4° ± 5.6°, 116.4° ± 7.2°, and 117.5° ± 6.1°, respectively, with significant difference found between group 1 and group 2 (p < 0.05), and between group 1 and group 3 (p < 0.05). However, the gender, age, and body mass index (BMI) did not differ between three groups and there was no significant difference between groups in terms of pre−/postoperative HSS scores or postoperative knee ROM. Conclusion A mid-term follow-up showed that an appropriate PTS (4° ~ 7°) can help improve the postoperative flexion of knee. On the other hand, too small a PTS could lead to limited postoperative knee flexion. Therefore, the PTS less than 4° should be avoided during medial UKA.

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Analyzing the Magnitude of Interlimb Asymmetries in Young Female Soccer Players: A Preliminary Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020475 ◽

2021 ◽

Vol 18 (2) ◽

pp. 475

Author(s):

Javier Raya-González ◽

Filipe Manuel Clemente ◽

Daniel Castillo

Keyword(s):

Range Of Motion ◽

Muscle Mass ◽

Injury Risk ◽

Young Female ◽

Asymmetry Index ◽

Lower Limbs ◽

Soccer Players ◽

Countermovement Jump ◽

Change Of Direction ◽

Jump Ability

Although asymmetries in lower limbs have been linked with players’ performance in male soccer players, literature that has been published addressing female soccer is scarce. Thus, the aim of this study was twofold: (i) describe the asymmetries of women soccer players during jumping, change-of-direction and range-of-motion tests; and (ii) test possible relationships between asymmetries and injury risk in female soccer players. Sixteen female players (15.5 ± 1.5 years) performed a battery of fitness tests (i.e., jump ability, change-of-direction ability and passive range-of-motion) and muscle mass analysis via dual-energy X-ray absorptiometry, through which the specific asymmetry index and the related injury risk were calculated. Significant (p < 0.05) lower asymmetries in the change-of-direction test were observed in comparison to those observed in jumping and range-of-motion tests; significant (p < 0.05) lower asymmetries in muscle mass were also reported compared to those found in the change-of-direction and countermovement jump tests. Additionally, increased injury risk for countermovement jump and hip flexion with extended knee range-of-motion (relating to asymmetry values) and for ankle flexion with flexed knee range-of-motion in both legs (relating to reference range-of-motion values), as well as increased individual injury risk values, were observed across all tests. These findings suggest the necessity to implement individual approaches for asymmetry and injury risk analyses.

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