Common Peroneal Nerve Injury in a Patient with COVID-19 Infection

This report described a 46-year man with the characteristic Computerized Tomography (CT) scan findings of Corona Virus Disease Infection 19 (COVID-19) who presented to the hospital with right ankle weakness three weeks after the pneumonitis. He had been initially hospitalized, complaining of fever, myalgia, cough, and dyspnea. Electromyogram (EMG) revealed obvious evidence of increased insertional activity (IA) and significant denervation potentials, including positive sharp waves (PSW) and fibrillation potentials, particularly in ankle dorsiflexor muscles. Moreover, no voluntary motor unit action potential (MUAP) was observed. Eventually, the patient was diagnosed with severe axonal mononeuropathy of the right CPN, which could be considered a rare complication of COVID-19.

Machine learning analysis to predict the need for ankle foot orthosis in patients with stroke

We investigated the potential of machine learning techniques, at an early stage after stroke, to predict the need for ankle–foot orthosis (AFO) in stroke patients. We retrospectively recruited 474 consecutive stroke patients. The need for AFO during ambulation (output variable) was classified according to the Medical Research Council (MRC) score for the ankle dorsiflexor of the affected limb. Patients with an MRC score of < 3 for the ankle dorsiflexor of the affected side were considered to require AFO, while those with scores ≥ 3 were considered not to require AFO. The following demographic and clinical data collected when patients were transferred to the rehabilitation unit (16.20 ± 6.02 days) and 6 months after stroke onset were used as input data: age, sex, type of stroke (ischemic/hemorrhagic), motor evoked potential data on the tibialis anterior muscle of the affected side, modified Brunnstrom classification, functional ambulation category, MRC score for muscle strength for shoulder abduction, elbow flexion, finger flexion, finger extension, hip flexion, knee extension, and ankle dorsiflexion of the affected side. For the deep neural network model, the area under the curve (AUC) was 0.887. For the random forest and logistic regression models, the AUC was 0.855 and 0.845, respectively. Our findings demonstrate that machine learning algorithms, particularly the deep neural network, are useful for predicting the need for AFO in stroke patients during the recovery phase.

Association of affected lower limb flexor muscle strength with swing phase duration and gait speed in elderly post-stroke patients

BACKGROUND: Although several studies have shown an association of muscle weakness with gait speed (GS), no study has explored the relationship of muscle strength with swing phase duration and GS after stroke among the elderly in Saudi Arabia. OBJECTIVE: To examine the association of affected ankle dorsiflexor and hip flexor muscle strength with swing phase duration and GS in the elderly with different stroke chronicity. METHODS: In this cross-sectional study, we included a total of 60 post-stroke patients aged ≥55 years who were admitted in neurorehabilitation units between May 2017 and August 2018. Linear regression was employed to examine the association of muscle strength (measured using a handheld dynamometer) with swing phase duration and GS (both measured using the computerized Zebris–Mat). RESULTS: The chronicity of the stroke was negatively associated (p < 0.05) with swing phase duration. The ankle dorsiflexor muscle strength was significantly associated with GS (β= 0.656, p = 0.041). In contrast, hip flexor muscle strength was significantly associated with GS (β= 0.574, p < 0.0001) even after adjusting for stroke chronicity (β= 0.561, p < 0.0001). CONCLUSIONS: Stroke chronicity was the predictor that reduced swing phase duration. The ankle dorsiflexor muscle strength was associated with GS. However, the hip flexor muscle strength was associated with GS even after adjusting for stroke chronicity.

Efficacy of ankle kinesiotape on balance in children with spastic diplegia

Background Adequate and efficient standing postural balance is key for functional walking and handling abilities in children with spastic diplegia. This study was designed to evaluate the effect of kinesiotape applied on ankle dorsiflexor muscles on balance in children with spastic diplegia. Thirty children with spastic diplegia of both genders participated in the study: 16 boys and 14 girls between 4 and 10 years old. They were divided randomly and equally into two groups: a control group, in which children received the standard physical therapy program for children with diplegia; and the study group, who received the same physical therapy program as in the control group but after kinesiotape application over the ankle dorsiflexor muscles. Both groups received the treatment program for 1 h, three times per week, for three successive months. Postural stability was assessed through evaluation of three stability index (anteroposterior, mediolateral, and overall) for all children by the Biodex Balance System before and after treatment. Results Statistical analysis of results before and after treatment was performed by mixed MANOVA to compare effects both within and between groups on stability indexes, and post hoc tests were carried out for subsequent multiple comparison. The level of significance for all statistical tests was set at p < 0.05. Before treatment, there was no significant difference in the stability index between both groups (p > 0.05). Comparison between both groups post-treatment revealed a significant decrease in the measured variables of the study group compared with that of the control group (p < 0.05). Conclusion Adding ankle kinesiotaping over dorsiflexor muscles in conjunction with a balance and gait training exercise program for children with diplegia can enhance postural stability and decrease sway. This study suggests that it should be added to the treatment program for children with diplegia. Trial registration This study was registered retroactively. Identifier: NCT04243928

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.

97 Effect of Functional Electrical Stimulation of Ankle Muscles in Standing Positions on Postural Stability in Elderly Adults

Introduction Declines in postural stability in standing with aging are associated with a reduction in ankle muscle control. Increasing postural sway may lead to fall and limit activities of daily living in elderly people. There are evidences demonstrate that exercise interventions can improve postural stability and decrease risk of falling. However, to our knowledge, there are no studies have reported the effect of functional electrical stimulation (FES) of ankle muscles on postural stability in elderly people. So, the purpose of this study was to determine the effect of 4-week FES protocols applied to ankle dorsiflexor and plantar flexor muscles on postural stability in elderly adults. Methods Ten elderly adults (67.5±6.9) participated in this study. Electrical stimulation (biphasic pulse current with a pulse duration of 0.3 ms, 50 Hz) for bilateral ankle dorsiflexor and plantar flexor muscles combined with standing balance, 3 times a week for 4 weeks. Postural sway was assessed using Lord’s sway meter during standing on 4 sensory conditions. Balance and gait speed were assessed using short physical performance battery (SPPB). All outcome measures were performed before and after 4-week period. Results After 4-week, all subjects showed decreased postural sway during standing on 4 sensory conditions. But statistical significance was clearly achieved for eyes closed and closed on foam surface condition. Gait speed time and score of SPPB was significantly different between before and after training. Discussion and Conclusion Findings from this study showed that FES of ankle muscles in standing positions for 4-week period could improve postural stability and gait speed in elderly adults. The decrease in postural sway could possibly explain by the better coordinated control of both ankle dorsiflexor and plantar flexor muscles in standing balance. However, this study assessed only the immediate effect of training. Further study should be to determine whether long-term effect.

The Acute Effect of Talocrural Joint Mobilization on Dorsiflexor Muscle Strength in Healthy Individuals: A Randomized Controlled Single-Blind Study

Context: Mobilization has been used for enhancing muscle strength. Objective: The aim of this study was to investigate the acute effect of talocrural joint mobilization on ankle dorsiflexor muscle strength in healthy individuals, which has not yet been studied. Design: Randomized controlled single-blind study. Setting: University laboratory. Participants: Forty-eight healthy individuals. Interventions: Maitland grade III (study group) versus Maitland grade I (control group) mobilizations. Main Outcome Measures: Muscle strength measurements were performed using a handheld dynamometer at baseline, immediately after the mobilization, and 30 minutes after mobilization. Results: At baseline, the physical characteristics and muscular strength were similar in both groups (P > .05). According to Friedman analysis, a significant difference was detected following the mobilization in the study group (P < .001), and while the muscle strength at immediately after the mobilization and at 30 minutes after mobilization was significantly higher than baseline (P < .001), no significant differences were observed between 30 minutes after mobilization and immediately after the mobilization (P = .17). However, no significant changes were detected in the control group. The study group was found superior to the control group in terms of muscle strength differences following the mobilization (P < .001). Conclusion: The ankle dorsiflexor muscle strength might be increased by performing Maitland grade III mobilization, and this increase might be preserved for 30 minutes, while Maitland grade I mobilization did not lead to such an improvement in healthy individuals.