NeuroRehabilitation - Volume 33, issue 3

Authors: Pellicane, Anthony J. | Millis, Scott R. | Barker, Kim D.D. | Temme, Kate E. | Sayyad, Anjum | Oswald, Matthew C. | Roth, Elliot J.

Article Type: Research Article

Abstract: Background: Nutrition's impact on stroke rehabilitation outcomes is controversial. Existing studies utilize albumin without correcting for inflammation in nutritional assessments. Here, prealbumin was used and inflammation assessed to determine if nutrition impacts rehabilitation outcomes. Objective: Determine the effect of dietary intake on prealbumin level, number of complications, length of stay, and Functional Independence Measure (FIM) efficiency in rehabilitation stroke inpatients. Methods: Patients had admission and discharge prealbumin and C-reactive protein (CRP) levels drawn; and, weekly protein and calorie counts obtained. Patients were followed for number of complications, length of stay, and FIM efficiency. Results: …Mean protein and calorie intake was 57.6 ± 16.2 g/d and 1452.2 ± 435.8 kcal/d, respectively. 77.6% of patients had normal prealbumin on admission with 94.9% on discharge. Prealbumin increased significantly from admission to discharge (22.3 ± 6.2 mg/dL vs. 24.6 mg/dL ± 5.1 mg/dL, P = 0.007). Number of complications and length of stay were predicted by CRP in regression models. Total, motor, and cognitive FIM efficiencies were not universally affected by prealbumin levels, protein intake, or calorie intake. Conclusions: Nearly all hypoprealbuminemic stroke rehabilitation inpatients correct their levels eating a non-supplemented diet. Number of complications, length of stay, and functional outcomes in this patient are not affected by prealbumin levels, protein intake, or calorie intake. Show more

Keywords: Stroke, rehabilitation, malnutrition, treatment outcome

DOI: 10.3233/NRE-130966

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 367-376, 2013

Authors: Broetz, Doris | Birbaumer, Niels

Article Type: Case Report

Abstract: Introduction: Behavioral aspects of motor learning such as definition and assessment of patient-centered goals, specific motivation, training in the patients' environment, autonomous training and generalization of newly learned skills to daily life are not an explicit part of physiotherapy in neurorehabilitation. Behavioral physiotherapy: Specific goals are defined and applied in a step by step manner. Exercises and application in daily life were trained and anticipated as a “self control cue” for the following week. Motivation was sustained via supervision, feedback after successful trials and reward. Exercises have to occure at a daily basis and have to be implemented …in everyday life. Case description: A 54 year old man who suffered cerebral bleeding with left hemiparesis 25 years ago. We report goal attainment, change of symptoms and walking capacities over a period of 18 months. Results: Back pain and knee pain reduced to zero, rhythmic walking, walking speed increased, left leg less resistance, running possible. Discussion: The here described principles of behavioral physiotherapy are crucial for successful outcome in extremely stable and persistent consequences of stroke. Studies with more patients are needed to strengthen our hypothesis. Show more

Keywords: Stroke rehabilitation, physiotherapy, behavior, motor learning

DOI: 10.3233/NRE-130967

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 377-384, 2013

Authors: Chelette, Kenneth C. | Carrico, Cheryl | Nichols, Laurie | Sawaki, Lumy

Article Type: Research Article

Abstract: Background: Stroke continues to be a major public health concern in the United States. Motor recovery in the post-acute stages of stroke is possible due to neuroplasticity, or the capacity of the brain to reorganize. Objective: This case study tracks neuroplastic and motor change in a subject with severe hemiparesis following an extensive middle cerebral artery stroke. He had absence of ipsilesional motor evoked potentials in early evaluations. This report is unique in that the duration of follow-up evaluation extends nearly 2 years, with evaluations being performed at 7, 9, 10, 13, 20, and 21 months post-stroke. …Methods: At each evaluation we used transcranial magnetic stimulation to track neuroplastic change and the Fugl-Meyer Assessment and the Wolf Motor Function Test to evaluate upper extremity motor performance. Results: The contralesional hemisphere showed dynamic change throughout the study period. In contrast, the ipsilesional hemisphere demonstrated notable change only between 13 and 21 months post-stroke, with the most dramatic change occurring between 20 and 21 months post-stroke. Motor performance generally improved throughout the study period. Conclusions: Our findings demonstrate that substantial neuroplasticity-mediated motor recovery can occur nearly 2 years after stroke in an individual with severe post-stroke motor impairment. Show more

Keywords: Neuroplasticity, rehabilitation, transcranial magnetic stimulation, chronic, upper extremity

DOI: 10.3233/NRE-130968

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 385-389, 2013

Authors: Kwon, Oh Sung | Lee, Seung Won

Article Type: Research Article

Abstract: Objective: To determine the repeated passive movement (RPM) and repeated active movement (RAM) exercise on position sense of the knee joint in patients with hemiplegia. Methods: 45 hemiplegia patients were randomly allocated to either the control group(no exercise), RPM group, or RAM group, with 15 subjects in each group. The exercise was repeated 60 times on the angle 10 to 100 degrees of the knee joint with an angle speed of 120°/s, with three sets for 15 minutes. Evaluation was performed using Passive Angle Repositioning (PAR) and Active Angle Repositioning (AAR). Results: Error of positioning sense …showed a decrease in PAR and AAR in the RPM group (p < 0.01) and an increase in AAR was observed in the RAM group (p < 0.05). In comparison of knee joint position sense error value and rate of change among the three groups, the RPM group is decreased mostly in PAR and AAR (p < 0.01), and Error value (p < 0.05) and rate of change (p < 0.01) of the RAM group showed a greater increase in AAR than the control group. Conclusion: RAM exercise can support an increase in proprioception on the knee joint of hemiplegia; however, RAM exercise that causes fatigue can decrease proprioception. Show more

Keywords: Repeated passive movement, fatigue, joint position sense, knee, hemiplegia

DOI: 10.3233/NRE-130969

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 391-397, 2013

Authors: Troncati, Franco | Paci, Matteo | Myftari, Tefta | Lombardi, Bruna

Article Type: Research Article

Abstract: Background: Extracorporeal Shock Wave Therapy (ESWT) has been proposed for treatment of abnormal muscle tone only in the last years. The effects on motor impairment are unknown. Objective: To assess the long-term effects of ESWT on muscle tone and motricity in upper limb in patients with chronic hemiplegia. Methods: Twelve patients were selected and treated with two sessions of ESWT. Participants were assessed at baseline, after the treatment, and at 3 and 6 months. Muscle tone of shoulder adductors, elbow, wrist and finger flexors was evaluated at all assessment points using the Modified Ashworth Scale (MAS), …while motricity, passive range of motion (PROM) and pain sub-scores of upper extremity part of the Fugl-Meyer scale were used to assess motor recovery. The degree of perceived benefit from treatment was assessed on a visual analogue scale. Results: MAS showed a significant reduction of spasticity and Fugl-Meyer scores improved immediately after treatment. Persistent effects were observed at 3 and 6 months for MAS, and for motricity and PROM subscores of the Fugl-Meyer scale. Clinical improvement was not correlated to the patients' perceived benefit. Conclusions: Two sessions of ESWT seem to have long-term effects in reducing muscle tone and enhancing motor impairment. Show more

Keywords: Extracorporeal shock wave therapy, muscle spasticity, rehabilitation, stroke, paresis

DOI: 10.3233/NRE-130970

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 399-405, 2013

Authors: Sung, Yun-Hee | Kim, Chang-Ju | Yu, Byong-Kyu | Kim, Kyeong-Mi

Article Type: Research Article

Abstract: Aim: We investigated whether a hippotherapy simulator has influence on symmetric body weight bearing during gait in patients with stroke. Method: Stroke patients were divided into a control group (n = 10) that received conventional rehabilitation for 60 min/day, 5 times/week for 4 weeks and an experimental group (n = 10) that used a hippotherapy simulator for 15 min/day, 5 times/week for 4 weeks after conventional rehabilitation for 45 min/day. Temporospatial gait assessed using OptoGait and trunk muscles (abdominis and erector spinae on affected side) activity evaluated using surface electromyography during sit-to-stand and gait. Prior to starting the …experiment, pre-testing was performed. At the end of the 4-week intervention, we performed post-testing. Result: Activation of the erector spinae in the experimental group was significantly increased compared to that in the control group (p < 0.01), whereas activation of the rectus abdominis decreased during sit-to-stand. Of the gait parameters, load response, single support, total double support, and pre-swing showed significant changes in the experimental group with a hippotherapy simulator compared to control group (p < 0.05). Moreover, activation of the erector spinae and rectus abdominis in gait correlate with changes of gait parameters including load response, single support, total double support, and pre-swing in experimental group. Conclusion: These findings suggest that use of a hippotherapy simulator to patients with stroke can improve asymmetric weight bearing by influencing trunk muscles. Show more

Keywords: Stroke, hippotherapy simulator, gait performance, trunk muscle

DOI: 10.3233/NRE-130971

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 407-412, 2013

Authors: Meier Khan, Christine | Oesch, Peter

Article Type: Research Article

Abstract: Background: Rehabilitation of patients after stroke requires valid and responsive assessments for arm and hand function to determine the effectiveness of rehabilitative interventions. The Motor Activity Log (MAL) aims to assess self-perceived arm and hand use after stroke. Its clinimetric properties are incomplete and contradictory. Objective: To investigate internal consistency, concurrent validity and responsiveness of the German MAL-30 in patients after stroke with minimal to moderate arm and hand function. Methods: 42 patients were included in this longitudinal prospective cohort study. Internal consistency was determined in a complete-case analysis with Cronbach's α. Concurrent validity was assessed …with Spearman' rho by comparing the German MAL-30 with Wolf Motor Function Test, Chedoke McMaster Stroke Assessment, isometric elbow, shoulder and grip strength at baseline, post-treatment and 6 month follow-up. Responsiveness was determined separately for lower and higher arm and hand function by calculating the standardized response mean. Results: Internal consistency was excellent (Cronbach's α = 0.94–0.99), concurrent validity good to excellent (Spearman's rho = 0.64–0.99). Responsiveness was high for both functional levels from baseline to discharge (SRM = 0.93–1.43) and to follow-up (SRM = 0.95–1.34). Conclusion: The German MAL-30 is a valid and responsive assessment for self-perceived arm and hand use after stroke even when function is low. Show more

Keywords: Stroke, assessment, arm- and hand use, self-perceived

DOI: 10.3233/NRE-130972

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 413-421, 2013

Authors: Kalron, Alon | Dvir, Zeevi | Gurevich, Michael | Achiron, Anat

Article Type: Research Article

Abstract: Background: Factors determining the clinically isolated syndrome (CIS) patient's likelihood of developing multiple sclerosis (MS) are important for the clinician who needs to identify patients warranting immunomodulatory treatments. Objective: To determine whether motor abnormalities found during the initial demyelinating event imply an increased risk of a second event within the first year. Methods: Fifty-two early onset CIS patients, volunteered to participate in the prospective study. Motor parameters collected at onset included gait, balance, lower limb peak isometric strength and fatigue index parameters. At the end of one year, patients were subdivided into two groups, those who …had experienced a second demyelinating attack suggestive of MS and those who maintained their clinical status. Results: Forty-nine patients were included in the final analysis. Within the first year, 24 patients experienced a second attack, while 25 maintained their neurological status. Patients who suffered a second demyelinating attack, demonstrated reduced overall lower limb peak strength compared with patients who maintained their clinical status (411.9 (S.E. = 32.1) vs. 514.8 (S.E. = 34.1). No differences were observed between groups in gait and balance parameters. Conclusion: An initial demyelinating event characterized by reduced lower limb strength can possibly suggest an increased risk of an early second attack. Show more

Keywords: Multiple sclerosis, clinically isolated syndrome, motor fatigue, gait, muscle strength, balance

DOI: 10.3233/NRE-130973

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 423-430, 2013

Authors: Bayraktar, Deniz | Guclu-Gunduz, Arzu | Yazici, Gokhan | Lambeck, Johan | Batur-Caglayan, Hale Zeynep | Irkec, Ceyla | Nazliel, Bijen

Article Type: Research Article

Abstract: Background: Multiple Sclerosis (MS) patients are often referred to aquatic physical therapy, but unfortunately, researches on the effects of aquatic therapy in MS patients are limited. Objective: The purpose of this study was to investigate the effects of Ai-Chi on balance, functional mobility, strength and fatigue in ambulatory patients with MS. Methods: Twenty-three ambulatory female patients were divided into two groups as experimental (n = 15) or control (n = 8) for an 8-week treatment program. The experimental group underwent Ai-Chi exercises in a swimming pool and the control group performed active arm and leg exercises …combined with abdominal breathing exercises at home. Static standing balance was measured with duration of one-leg stance, functional mobility was evaluated with Timed-up and Go test and 6 minute walk test, upper and lower muscle strength was assessed with hand-held dynamometer and fatigue was evaluated with Fatigue Severity Scale. Results: Improvements were observed in static standing balance, functional mobility, upper and lower extremity muscle strength and fatigue in the Ai-Chi group (p < 0.05), but no significant differences in any outcome measures were observed in the control group (p > 0.05) after the intervention. Conclusions: According to these findings Ai-Chi may improve balance, functional mobility, upper and lower extremity muscle strength and fatigue in patients with MS. Show more

Keywords: Multiple sclerosis, aquatic therapy, Ai-Chi, balance

DOI: 10.3233/NRE-130974

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 431-437, 2013

Authors: Feys, Peter | Tytgat, Katrien | Gijbels, Domien | De Groote, Luc | Baert, Ilse | Van Asch, Paul

Article Type: Research Article

Abstract: Background: Persons with MS (pwMS) in the community show reduced physical activity while studies demonstrated beneficial effects of exercise therapy in supervised settings. Objective: This study investigated, in pwMS living in the community, the effects of a 1-day education program about exercises and sports, on physical activity behavior and related outcome measures as self-efficacy, perceived walking ability, fatigue, perceived impact of MS and quality of life. Methods: PwMS attended an education day with theoretical and practical sessions that was organized by the Flemish MS Society and professional exercise experts. Forty-two participants immediately completed questionnaires as well …as after three and six months. Overall disability and physical activity level were measured using PDSS (patient determined disease steps) and PASIPD (Physical Activity Scale for Individuals with Physical Disabilities) respectively. Other outcomes were the ESES, MSWS-12, MFIS, MSIS-29 and SF-36. Analyses of variance were performed in groups distinguished by self-reported disability level (PDDS ≤1; n = 24 and PDSS >1; n = 18). Results: Groups differed significantly for perceived walking ability (PDDS,MSWS-12) and physical related-domains of MSIS-29 and SF-36, but not PASIPD. A trend towards significant group*time interaction effect was found for the PASIPD indicating, at 3 and 6 months, increased physical activity in the subgroup PDDS ≤1. For the MSIS-29, a significant time effect was found with reduced impact being largest for the more disabled group at 6 months. No changes were found in other outcome measures. Conclusion: An one-day education program had, depending on perceived disability level, some long-standing effects on physical activity and perceived impact of MS. Show more

Keywords: Multiple sclerosis, education program, physical activity, society

DOI: 10.3233/NRE-130975

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 439-448, 2013

Authors: Saunders, Lee L. | Ekoja, Ene | Whitlock, Chelsea S. | DiPiro, Nicole D. | Gregory-Bass, Rosalind | Krause, James S.

Article Type: Research Article

Abstract: Objective: The purpose of this study is to identify whether protective and risk health behaviors are more common among African Americans with spinal cord injury (SCI) compared with African Americans in the general population. Methods: Mail-in surveys were collected from 252 adult participants with SCI. Behavioral Risk Factor Surveillance System data from 2009 was downloaded. Results: Participants with SCI were more likely to report currently smoking. Among those who reported currently smoking, persons with SCI were less likely to report ever trying to quit. Those with SCI were also more likely to report consuming alcohol and …binge drinking in the past month. Participants with SCI were more likely to receive a flu shot/spray in the past year and to have ever received a pneumonia vaccine. Conversely, those with SCI were less likely to report ever having their blood cholesterol checked. Conclusions: Results of this study suggest that, consistent with previous research, individuals with SCI focused their preventive health behaviors on conditions consistent with SCI prophylactic standard of care (e.g., flu shots and pneumonia vaccines), as compared to behaviors intended to prevent chronic diseases consistent with the overall population. Show more

Keywords: Spinal cord injury, behaviors, disparities, risk, prevention

DOI: 10.3233/NRE-130976

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 449-456, 2013

Authors: Flansbjer, Ulla-Britt | Brogårdh, Christina | Lexell, Jan

Article Type: Research Article

Abstract: Objective: To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance. Methods: Ninety community-dwelling ambulant persons (47 men and 43 women; mean age 64 years SD 8) with late effects of polio participated. Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s and ankle dorsiflexor muscle strength at 30°/s. Gait performance was assessed by the Timed “Up & Go”, the Comfortable and Fast Gait Speed tests, and the 6-Minute Walk …test. Results: There were significant correlations between knee extensor and flexor muscle strength and gait performance (p < 0.01), and between ankle dorsiflexor muscle strength and gait performance (p < 0.05), for both lower limbs. Muscle strength in the knee extensors and flexors explained 7% to 37% and 9% to 47%, respectively, of the variance in gait performance. Strength in the ankle dorsiflexors explained 4% to 24%, whereas gender, age and BMI contributed at most an additional 9%. Conclusion: Knee muscle strength, and to some extent ankle dorsiflexor muscle strength, are predictors of gait performance in persons with late effects of polio, but the strength of the relationships indicates that other factors are also important. Show more

Keywords: Post poliomyelitis syndrome, gait, muscle strength

DOI: 10.3233/NRE-130978

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 457-464, 2013

Authors: Baek, Seung Ok | Kim, Oh Lyong | Kim, Seong Ho | Kim, Min Soo | Son, Su Min | Cho, Yoon Woo | Byun, Woo Mok | Jang, Sung Ho

Article Type: Research Article

Abstract: Objectives: Many diffusion tensor imaging (DTI) studies have reported an association between cingulum injury and cognition in patients with traumatic brain injury (TBI) using DTI parameters. In this study, we attempted to investigate the relation between cingulum injury and cognition in chronic patients with TBI, using the integrity of the cingulum as well as DTI parameters. Method: Thirty five consecutive chronic patients with TBI were recruited. The intelligence quotient (IQ) of the Wechsler Intelligence Scale and Memory Assessment Scale (MAS) was used for assessment of cognition. The patients were classified into three groups, according to continuity to the …lower portion of the genu of the corpus callosum: type A-both sides of the cingulum showed intact continuity, type B-either cingulum showed a discontinuation, and, type C-both cingulums showed discontinuation. We measured the fractional anisotropy (FA), apparent diffusion coefficient (ADC), and voxel number of both cingulums. Results: The IQ and MAS scores of type A and B were significantly higher than those of type C, respectively (p < 0.05), however, we did not observe a significant difference between type A and type B (p > 0.05). A positive correlation was observed between the FA value of the cingulum, and IQ and MAS, respectively (IQ r = 0.373, p < 0.05, MAS r = 0.357, p < 0.05), and between the voxel number and MAS (r = 0.500, p < 0.05). By contrast, we observed a negative correlation between the ADC value and IQ (r = −0.353, p < 0.05). Conclusion: In terms of integrity to the basal forebrain and DTI parameters of the injured cingulum, DTI findings showed a close association with whole cognition and memory in chronic patients with TBI. Show more

Keywords: Cognition, memory, traumatic brain injury, cingulum, diffusion tensor imaging

DOI: 10.3233/NRE-130979

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 465-471, 2013

Authors: Kammersgaard, Lars Peter | Linnemann, Mia | Tibæk, Maiken

Article Type: Research Article

Abstract: Objective: To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI). Background: Posttraumatic hydrocephalus (PTH) may lead to clinical deterioration and poor outcome if untreated. However, PTH can be successfully treated if detected. Nevertheless, PTH is easily overlooked during rehabilitation, particularly in severe cases. Method: We prospectively followed all patients (n = 444) in Eastern Denmark (population 2.5 mill) sustaining severe TBI, who required lengthy rehabilitation between 2000 and 2010. All patients with PTH were tracked retrospectively. Demographics, surgery, injury severity, consciousness level, and …disability were compared for patients with versus without PTH. Independent predictors of PTH during rehabilitation were identified through multiple logistic regression models. Results: PTH occurred in 14.2% and 3/4 emerged during rehabilitation. Patients with PTH were older, had more severe brain injuries, were more frequently in vegetative state, and needed longer rehabilitation stays. After adjusted analyses, however, only older age and low level of consciousness were independently associated with PTH. Conclusion: Most cases of PTH emerge during rehabilitation. Therefore, attention towards this complication should be present also beyond the acute stage after TBI, particularly among older patients and patients with severe disordered consciousness. Show more

Keywords: Brain injury, traumatic, hydrocephalus, rehabilitation, prediction

DOI: 10.3233/NRE-130980

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 473-480, 2013

Authors: Worthen-Chaudhari, Lise | Whalen, Cara N. | Swendal, Catherine | Bockbrader, Marcia | Haserodt, Sarah | Smith, Rashana | Bruce, Michael Kelly | Mysiw, W. Jerry

Article Type: Research Article

Abstract: Background: Interactive arts technologies, designed to augment the acute neurorehabilitation provided by expert therapists, may overcome existing barriers of access for patients with low motor and cognitive function. Objectives: Develop an application prototype to present movement feedback interactively and creatively. Evaluate feasibility of use within acute neurorehabilitation. Methods: Record demographics and Functional Independent Measure™ scores among inpatients who used the technology during physical, occupational or recreational therapy. Record exercises performed with the technology, longest exercise duration performed (calculated from sensor data), user feedback, and therapist responses to a validated technology assessment questionnaire. Results: Inpatients …(n = 21) between the ages of 19 and 86 (mean 57 ± 18; 12 male/9 female) receiving treatment for motor deficits associated with neuropathology used the application in conjunction with occupational, recreational, or physical therapy during 1 to 7 sessions. Patients classified on the Functional Independence Measure™ as requiring 75%+ assistance for cognitive and motor function were able to use the interactive application. Conclusions: Customized interactive arts applications are appropriate for further study as a therapeutic modality. In addition to providing interactivity to individuals with low motor function, interactive arts applications might serve to augment activity-based medicine among inpatients with low problem-solving and memory function. Show more

Keywords: Movement, therapy, patient compliance, neuromuscular diseases, virtual reality, interactive art, biomechanics

DOI: 10.3233/NRE-130981

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 481-490, 2013

Authors: Miljković, Nadica | Milovanović, Ivana | Dragin, Aleksandra | Konstantinović, Ljubica | Popović, Dejan B.

Article Type: Research Article

Abstract: Background: The main clinical measures of walking recovery in stroke patients were compared for training assisted by Walkaround® postural support (WPS) and conventional (CON) support by a cane/therapist. Objective: We attributed the differences between the trainings to modified muscular synergies that occurred during assistance by WPS. Methods: We studied the muscle activities of the primary knee and ankle joint movers in the paretic and non-paretic legs of sub-acute stroke patients during assisted walking with WPS and CON. Recorded signals were compared to normative data that were recorded during speed-matched gait trials in healthy subjects. The specific …measures were the relative contribution of individual muscles, levels of cocontraction, and the timing of the maximum electromyography (EMG) activity during the walking sessions. Results: We found that, for most patients, the individual contribution of muscles were more similar to the healthy with the WPS assistance. In parallel, the cocontraction of the rectus femoris muscles in both legs was lower (by up to 39 %) during walking assisted by WPS than by cane/therapist gait support); the results from this case series (10 patients) showed that WPS might be the superior training scheme. Conclusions: These findings indicated that assistance by WPS changed the motor control output relative to CON assistance in most patients. Show more

Keywords: EMG, posture, rehabilitation, stroke, synergy

DOI: 10.3233/NRE-130982

Citation: NeuroRehabilitation, vol. 33, no. 3, pp. 491-501, 2013