From studies of moments of force and mechanical power produced by the muscle activations during walking, we know that the main propulsive force comes from the push-off contraction of the ankle plantarexors generation of power at the end of the stance phase aided by the pull-off contraction of the hip exors generation of power at swing initiation and the contraction of the hip extensors in early stance Olney et al. Moreover, in persons with chronic stroke, Olney et al.
These laboratory results point to the ankle plantarexors and hip exors as muscles to be targeted in therapy to promote better walking speed Olney et al. While gait speed can be used to discern a change in functional status, it does not explain why the person walks faster. An analysis of gait kinetics muscle activations, moments, powers, work is needed to pinpoint the source of the increased speed. For example, in a recent trial evaluating the effects of task-oriented physical therapy, Richards et al.
Many new therapeutic approaches and outcome measures are rst developed in the laboratory. Much work, for example, has been done on obstacle avoidance in healthy persons McFadyen and Winter, ; Grin-Lajoie et al. Virtual reality technology is now being applied to the development of training paradigms to enable persons with stroke to practice navigational skills safely in changing contextual environments Comeau et al. An example of the use of laboratory data to validate a clinical measure is recent work related to the rise-to-walk test.
The clinical uidity scale of the rise-to-walk test was validated by comparing clinical decisions to the smoothness of the momentum curve derived from a biomechanical analysis made in the laboratory Dion et al. Neuroimaging techniques for studying changes in brain activation patterns and their relationship with functional recovery With the rapid development of neuroimaging techniques Volume II, chapter 5 , such as positronemitted tomography PET , functional magnetic resonance imaging fMRI and transcranial magnetic stimulations TMS; Volume I, Chapter 15 , it has become possible to study neural organization associated with motor recovery after brain damage.
Numerous studies have looked at the predictive value of TMS Hendricks et al. It provides important prognostic information in the early stage after stroke. For instance, the persistence of motor evoked potentials MEPs in paretic muscles has been correlated with good motor recovery, whereas the lack of TMS responses is predictive of poor motor recovery. Patterns of brain activation can also be used early after stroke for predicting functional outcomes. In a longitudinal fMRI study, where hand motor scores were compared to the whole sensorimotor network activation, the early recruitment and high activation of the supplementary motor area SMA was correlated with faster or better recovery Loubinoux et al.
Based on ndings from a study combining fMRI and TMS, it has been proposed that the early bilateral activation of the motor networks seen in patients with rapid and good recovery may be a prerequisite to regain motor function rapidly, and thus, may be predictive of motor recovery Foltys et al. Functional imaging and electrophysiologic brain imaging techniques have provided substantial information about adaptive changes of cerebral networks associated with recovery from brain damage Calautti and Baron, For example, in two rigorously controlled studies, the effects of taskoriented training for the upper limb on brain activation patterns were studied using fMRI Carey et al.
Both studies found that, in contrast to patients in control groups whose brain activation patterns remained unchanged, patients in the treatment groups displayed enhanced activations in the lesioned sensorimotor cortex in parallel with improved motor function. Similar correlations between changes in brain activation patterns and motor recovery have also been reported after a single dose of uoxetine Pariente et al. TMS mapping studies Liepert, provide further evidence of a relationship between traininginduced cerebral changes and motor recovery.
In these studies, TMS was used to map the motor output area motor representation of targeted muscles. Increased cortical excitability and a shift in the motor maps after active rehabilitation Traversa et al. Recently, the laterality index LI has been proposed to quantify changes of brain activation patterns observed in functional neuroimaging studies of recovery post-stroke Cramer et al. LI provides an estimate of the relative hemispheric activation in motor cortices.
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LI values range from 1 activation exclusively ipsilesional or affected hemisphere to 1 activation exclusively contralesional or unaffected hemisphere. These LIs are generally lower in patients, especially in poorly recovered chronic patients, indicating a relatively greater activation of the unaffected hemisphere consistent with the aforementioned general patterns of changes Calautti and Baron, Dynamic changes in LI values over time have also been reported in a longitudinal study Marshall et al.
After specic nger-tracking training, Carey. Comparisons of the excitability of the motor cortex of the two hemispheres Fig. In contrast,. Each symbol normal curves from a c healthy subject LI Schneider and Malouin, unpublished data.
These examples show the potential of combining clinical, laboratory and brain imaging measures to better understand the recovery of locomotor function after stroke. Brandstater, M. Hemiplegic gait: analysis of temporal variables. Arch Phys Med Rehabil, 64, Brook, R. Quality assurance today and tomorrow: forecast for the future. Ann Intern Med, 85, Calautti, C. Functional neuroimaging studies of motor recovery after stroke in adults. Stroke, 34, Dynamics of motor network overactivation after striatocapsular stroke: a longitudinal PET study using a xedperformance paradigm.
Stroke, 32, Cardol, M. Responsiveness of the impact on participation and autonomy questionnaire. The stroke rehabilitation assessment of movement STREAM : a comparison with other measures used to evaluate effects of stroke and rehabilitation. Phys Ther, 83, Beaton, D. A taxonomy for responsiveness. J Clin Epidemiol, 54, Berg, K. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can, 41, Dauphinee, S. A comparison of clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil, 73, Measuring balance in the elderly: validation of an instrument.
Can J Public Health, 83 Suppl. The balance scale: reliability assessment with elderly residents and patients with acute stroke. Scand J Rehabil Med, 27, Bjorner, J. Using modern psychometric methods to measure health outcomes. Med Outcome Trust Monit, 3, Bohannon, R. Strength of lower limb related to gait velocity and cadence in stroke patients. Physiother Can, 38, Nature, reliability, and predictive value of muscle performance measures in patients with hemiparesis following stroke.
Arch Phys Med Rehabil, 83, Carey, J. Analysis of fMRI and nger tracking training in subjects with chronic stroke. Brain, , Carroll, T. Reliability of the inputoutput properties of the cortico-spinal pathway obtained from transcranial magnetic and electrical stimulation. J Neurosci Method, , Cella, D. Core item banking programs: past, present and future. Cleary, P.
Future directions of quality of life research. Qual Life Med Rehabil, 83, Cohen, J. Coefcient of agreement for nominal scales. Educ Psychol Measure, 20, Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Collins, D. Pretesting survey instruments: an overview of cognitive methods.
Qual Life Res, 12, Comeau, F. Development of increasingly complex virtual environment for locomotor training following stroke. Cramer, S. A functional MRI study of subjects recovered from hemiparesis stroke. Stroke, 28, Cronbach, L. Coefcient alpha and the internal structure of tests. Psychometrika, 16, The two disciplines of scientic psychology. Am Psychol, 12, Crosby, R. Dening clinically meaningful change in health-related quality of life.
J Clin Epidemiol, 56, Daley, K. Physiother Can, 49, Phys Ther, 79, De Bruin, A. P Stevens, F. Assessing the responsiveness of a functional status measure: the sickness impact prole versus the SIP J Clin Epidemiol, 50, Dean, C. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil, 81, Walking speed over 10 metres overestimates locomotor capacity after stroke.
Clin Rehabil, 15, Desrosiers, J. Arm and leg impairments and disabilities after stroke rehabilitation: relation to handicap. Clin Rehabil, 17, Devanne, H. Inputoutput properties and gain changes in the human corticospinal pathway. Exp Brain Res, , Dietz, V. Electrophysiological studies of gait spasticity and rigidity: evidence that mechanical properties of muscles contribute to hypertonia.
Dion, L. Assessing mobility and locomotor coordination after stroke with the rise-to-walk task. Duncan, P. Randomized clinical trial of therapeutic exercise in sub-acute stroke. The stroke impact scale version 2. Evaluation of reliability, validity and sensitivity to change. Stroke, 30, Engardt, M. Body weight-bearing while rising and sitting down in patients with stroke. Scand J Rehabil Med, 24, Evans, M. Systematic and random error in repeated measurements of temporal and distance parameters of gait after stroke.
Phys Ther, 78, Finch, E. Physical Rehabilitation Outcome Measures. Decker Inc.
Fisher, W. Measurement-related problems in functional assessment. Am J Occup Ther, 47, Foltys, H. Motor representation in patients rapidly recovering after stroke: a functional magnetic resonance imaging and transcranial magnetic stimulation study. Clin Neurophysiol, , Fougeyrollas, P. Social consequences of long term impairments and disabilities: conceptual approach and assessment of handicap. Int J Rehabil Res, 21, Fugl-Meyer, A.
The post-stroke hemiplegia patient. A method for evaluation of physical performance. Scand J Rehabil Med, 7, Grin-Lajoie, M. Walking around static and mobile upright obstacles. World Congress of Biomechanics, Calgary, August. Guyatt, G. Measuring change over time: assessing the usefulness of evaluative instruments. J Chron Dis, 40, Methods to explain the clinical signicance of health status measures. Mayo Clinic Proc, 77, Hambleton, R. Comparison of classical test theory and item response theory and their applications to test development.
Educ Measure Issue Pract, 12, Fundamentals of Item Response Theory. Hays, R. Item response theory models. Responsiveness to change: an aspect of validity not a separate dimension. Qual Life Res, 1, Hendricks, H. Systematic review for the early prediction of motor and functional outcome after stroke by using motor-evoked potentials. Holden, M. Clinical gait assessment in the neurologically. Reliability and meaningfulness.
Phys Ther, 64, Hsu, A. Analysis of impairments inuencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. Arch Phys Med Rehabil, 84, Husted, J. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol, 53, Iyer, L. P and Dumas, H. Establishing minimal clinically important difference scores on the pediatric evaluation of disability inventory for inpatient rehabilitation.
Jaeschke, R. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trial, 10, Jorgensen, H. Recovery of walking function in stroke patients. The Copenhagen Stroke Study. Arch Phys Med Rehabil, 76, Juniper, E. How to develop and validate a new health-related quality of life instrument. Spilker, B. Kirshner, B. A methodological framework for assessing health indices.
J Chron Dis, 38, Knutsson, E. Different types of disturbed motor control in gait of hemiparetic patients. Lamontagne, A. Contribution of passive stiffness to ankle plantarexor moment during gait after stroke. Coactivation during gait as an adaptive behavior after stroke. J Electromyogr Kinesiol, 10, Locomotor task-specic measure of spasticity of plantarexor muscles after stroke. Arch Phys Med Rehabil, 82, Mechanisms of disturbed motor control in ankle weakness during gait after stroke.
Gait Posture, 15, Lerner-Frankiel, M. Functional community ambulation: What are your criteria? Clin Manage, 6, Liepert, J. TMS in stroke. Clin Neurophysiol, 56 Suppl. Treatment-induced cortical reorganization after stroke in humans. Stroke, 31, Likert, R. A technique for the development of attitudes. Educ Psychol Measure, 12, Loubinoux, I. Correlation between cerebral reorganization and motor recovery after subcortical infarcts. Neuroimage, 20, Lydick, E.
Interpretation of quality of life changes. Qual Life Res, 2, Macko, R. Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of hemiparetic gait in chronic stroke patients. A preliminary report. Mahoney, F. Rehabilitation of the hemiplegic patient: a clinical evaluation. Arch Phys Med Rehabil, 35, Malouin, F.cleatserwildsour.ml
Textbook of Neural Repair and Rehabilitation Medical Neurorehabilitation 2006
Assessment and training of locomotor function after stroke: evolving concepts. A uidity scale for evaluating the motor strategy of the rise-to-walk task after stroke. Working memory and mental practice after stroke. Arch Phys Med Rehabil, 85, Training mobility tasks after stroke with combined physical and mental practice: a feasibility study. Neurorehabil Neural Repair, 18, Marshall, R. Evolution of cortical activation during recovery from corticospinal tract infarction.
McFadyen, B. Anticipatory locomotor adjustments during obstructed walking. Neurosci Res Commun, 9, Development of Complex Virtual. Environments for Locomotor Training Following Stroke. McHorney, C. Generic health measurement: past accomplishments and a measurement paradigm for the 21st century. Ann Intern Med, 15, Moffet, H.
Load-carrying during stair ascent: a new functional test. Gait Posture, 1, Impact of knee extensor strength decits on stair ascent performance in patients after medial meniscectomy. Scand J Rehabil Med, 25, Nakamura, R. Walking cycle after stroke. Tohoku J Exp Med, , Nelles, G. Arm training induced brain plasticity in stroke studied with serial positron emission tomography. Neuroimage, 13, Nilsson, L. Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground.
Norman, G. Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life.
Textbook of Neural Repair and Rehabilitation Medical Neurorehabilitation
Med Care, 39, Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care, 41, Norton, B. Correlation between gait speed and spasticity at the knee. Phys Ther, 55, Olney, S. North American Stroke Meeting, Montreal. Neurol Rev, 5, Hemiplegic gait following stroke. Part I. Gait Posture, 4, P Monga, T. Arch Phys Med Rehabil, 72, P and McBride, I. Phys Ther, 74, Pariente, J.
Fluoxetine modulates motor performance and cerebral activation of patients recovering from stroke. Ann Neurol, 50, Perron, M. Assessing locomotor recovery after total hip arthroplasty with the timed stair test. Perry, J. Classication of walking handicap in the stroke population. Stroke, 26, Podsiadlo, D. The timed up an go. A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 39, Poissant, L. The development and preliminary validation of the preference-based stroke index PBS. Health Qual Life Outcome, 1, Portney, L. Foundations of Clinical Research: Applications to Practice, 2nd edn.
Potempa, K. Physiological outcomes of aerobic exercise training in hemiparetic stroke patients. Redelmeier, D. Assessing the minimal important difference in symptoms: a comparison of two techniques. J Clin Epidemiol, 49, Interpreting small differences in functional status: the six minute walk test in chronic lung disease patients.
Revicki, D. Health status assessment for the twenty-rst century: item response theory, item banking and computer testing. Qual Life Res, 6, Richards, C. EMG activity level comparisons in quadriceps and hamstrings in ve dynamic activities. Muscle activation level comparisons for determining functional demands of locomotor tasks. Semin Orthoped, 4, The relationship of gait speed to clinical measures of function and muscle activations during recovery post-stroke.
Gait velocity as an outcome measure of locomotor recovery after stroke. Recovery of ankle and hip power during walking after stroke. Can J Rehabil, 11, Assessment and rehabilitation. Clin Geriatric Med, 15, The role of technology in task-oriented training in persons with sub-acute stroke: a randomized controlled trail. Robinett, C.
Functional ambulation velocity and distance requirements in rural and urban communities. A clinical report. Phys Ther, 68, Said, C. Obstacle crossing in subjects with stroke. Arch Phys Med Rehabil, 80, Effect of stroke on step characteristics of obstacle crossing. Salbach, N. Responsiveness and predictability of gait speed and other disability measures in acute stroke.
A mobility intervention enhances walking competency in the rst year post-stroke: a randomized controlled trial. Clin Rehabil, 5, Assessing health status and quality of life instruments: attributes and review criteria. Qual Life Res, 11, Shumway-Cook, A. Motor Control: Theory and Practical Applications. Predicting the probability for falls in communitydwelling older adults. Phys Ther, 77, Environmental demands associated with community mobility in older adults with and without mobility disabilities.
Phys Ther, 82, I have only one quibble. Several photos are reproduced in black and white. Surely, more colors could have emphasized the eye-catching effect of the photos. Nonetheless, in its wide scope, comprehensiveness and currency this book is the best of its kind, and although the obstacles to repair and rehabilitation resulting from CNS damage still appear formidable, after reading this text one is led to believe that they will, in time, be overcome.
Until then, no matter how much is discovered, a lot more remains. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation.
Close mobile search navigation Article Navigation. Volume Article Contents. Kathy Keyvani, MD. Oxford Academic.
Textbook of Neural Repair and Rehabilitation: Medical Neurorehabilitation Volume 2
It covers the practical applications of the basic science principles presented in volume 1, provides authoritative guidelines on the management of disabling symptoms, and describes comprehensive rehabilitation approaches for the major categories of disabling neurological disorders. Emphasizing the integration of basic and clinical knowledge, this book and its companion are edited and written by leading international authorities. Together they are an essential resource for neuroscientists and provide a foundation for the work of clinical neurorehabilitation professionals.
Table of contents Preface; Neural repair and rehabilitation: an introduction; Part A. Technology of Neurorehabilitation: Part A1. Outcomes Measurement and Diagnostic Technology: 1. Outcomes measurement: basic principles and applications in stroke rehabilitation; 2.
Human voluntary motor control and dysfunction; 3. Assessments, interventions, and outcome measures for walking; 4. Electromyography in neurorehabilitation; 5.