Rehabilitation of walking with electromyographic biofeedback in foot-drop after stroke.
Intiso D, Santilli V, Grasso MG, Rossi R, Caruso I
Rehabilitation Center, IRCCS S. Lucia, Rome, Italy.
BACKGROUND AND PURPOSE: Alterations of gait cycle and
foot-drop on the paretic limb are characteristic of stroke patients.
Electromyographic biofeedback treatment has been used in rehabilitation of
walking, but results are controversial. We performed gait analysis to
evaluate the efficacy of electromyographic biofeedback compared with
physical therapy.
METHODS: Sixteen patients with ischemic stroke were
enrolled in the study. The experimental group (4 men, 4 women) received
electromyographic biofeedback treatment together with physical therapy.
The control group (5 men, 3 women) was treated with physical therapy only.
Clinical and functional evaluations before and after treatment were
performed using Canadian Neurological, Adams, Ashworth, Basmajian, and
Barthel Index scales. Computerized gait analysis was performed in all
patients.
RESULTS:
Electromyographic biofeedback patients showed significantly increased scores on the Adams scale (P < .05) and Basmajian scale (P < .01). Gait analysis in this group showed a recovery of foot-drop in the swing phase (P < .02) after training.
CONCLUSIONS:
Our data confirm that the electromyographic biofeedback technique increases muscle strength and improves recovery of functional locomotion in patients with hemiparesis and foot-drop after cerebral ischemia.
Publication Types:
 | Clinical trial |
| Randomized controlled trial |
PMID: 8202978, UI: 94262119
Indian J Pediatr 1992 Jan;59(1):37-51
VOJTA neurophysiologic therapy.
Bauer H, Appaji G, Mundt D
Institute of Social Pediatrics and Medicine for Adolescents,
University of Munich, Germany.
The reflexlocomotion acc. to VOJTA is a neurophysiologic facilitation
system for the whole CNS and neuromuscular apparatus. It consists of all
components, in a reciprocal manner of locomotion: (i) automatic control of
posture, (ii) uprighting, (iii) aimed movements. Consequently the
indications for this type of kinesiologic facilitation are really
extensive. In this article the following complete list of indications is
described: CCD (central coordination disorder), CP (cerebral palsy),
peripheral paresis, Spina bifida (MMC), Myopathies, congenital
malformations, orthopaedic problems, traumatic cross sections,
neuromuscular dysfunctions etc. Further the experiences of the treatment
in each disease are discussed.
Even EMG-detections have shown the effect of the therapy in peripheral
and central damage! Therefore a
good prognosis for improvement and rehabilitation can be given in a
large number of disorders, irrespective of age!
Publication Types:
Review
Review, tutorial
PMID: 1535338, UI: 92307773
NB! Sentralsykehuset i Akershus (SiA) har iflg. rykter en meget dyktig, tysk VOJTA-terapeut, som har anvendt denne terapien på et par slagpasienter, som i utgangspunktet fikk spesielt dårlige rehabiliteringsprognoser av de "vanlige" (Bobath) terapeutene. Og resultatet har sålangt jeg har fått referert langt overskredet de mest optimistiske forventningene! Svaret jeg ellers har fått på spørsmål om Vojta-behandling er at dette ikke anvendes på voksne slagpasienter her i landet, kun på barn.
Men som det skrives ovenfor: a good prognosis for improvement and rehabilitation can be given in a large number of disorders, irrespective of age!!
Det virker faktisk som om Vojta-metoden anvendt i slagterapi er generelt helt ukjent i fagmiljøene her(?) Mens den etter sigende er meget utbredt i vanlig slagbehandling bl.a. i Tyskland!
Brain-damaged rats grow new nerve fibers after treatment with antibody
LOS ANGELES (AP) -- Brain-damaged rats that were given injections of an
experimental treatment grew new nerve
fibers that once again let them climb ropes, grasp food pellets and
remove sticky tape from their front paws, scientists reported Monday.
Experts said the research could help lead to new approaches to
spinal cord and brain injuries in humans. These injuries are
particularly devastating because damaged
nerve fibers in adults do not regenerate on their own. The growth of
new nerve fibers in the rats enabled them to recover their ability to
function to "an amazing degree," said Martin
Schwab of the Institute
for Brain Research at the University of Zurich in Switzerland.
"If you test these animals for hand function, precision movements,
you find a recovery of the behavior which is almost 100 percent."
Regeneration of brain and spinal cord nerves is naturally
inhibited by proteins in the protective
sheaths of the nerve fibers. So Schwab and his colleagues devised an
approach to neutralize the proteins with a specially engineered antibody,
called IN-1.
Mice injected with the antibody sprouted healthy, new nerve fibers in
undamaged regions of their brains and spinal cords
that took over for the damaged ones. The nerves sprouted and
built new connections "which automatically seem to be the right
connections'", Schwab said. The damaged fibers also showed some
regeneration.
The ability of the antibody to promote new compensatory
growth, rather than just repair damaged nerve fibers, could be useful
in treating stroke, the researchers said.
klikk på pilen for flere detaljer 
(more)
Dr. Martin E. Schwab to Recieve First Ameritec Prize for Paralysis Research
Human Trials(??)
Arch Phys Med Rehabil 1993 Oct;74(10):1100-1106
Feedback of ankle joint angle and soleus electromyography in the rehabilitation of hemiplegic gait.
Colborne GR, Olney SJ, Griffin MP
Department of Anatomy, Queen's University, Kingston, Ontario, Canada.
A computer-assisted feedback system was developed to present to walking
subjects instantaneous feedback of their muscle activity or joint angular
excursions during gait. Targets for muscle activity or joint motion were
displayed on the feedback screen along with timing cues that prompted
muscle activity or joint flexion/extension at specific times during the
gait cycle. The purpose was to compare the effectiveness of joint angle
and electromyographic (EMG) feedback to a focused
program of physical therapy for gait. Eight hemiplegic stroke
patients were treated with ankle joint angle feedback, EMG biofeedback
from the soleus muscle, and conventional physical therapy for gait in a
three-period crossover design. PT was given either first or last
in the sequence of treatments. Gait analysis prior to and following
each type of treatment revealed that the feedback treatments resulted in significant
increases in stride length and walking velocity and in
positive changes in push-off impulse, gait symmetry, and standing
weight-bearing symmetry, as evaluated in a general linear model and
paired t-tests. Overall, physical therapy produced no
significant changes! However, when physical therapy was the
first treatment of the sequence, significant increases in stride length
and velocity were observed. When physical therapy was last, there were
significant negative changes in gait symmetry and standing weight-bearing
symmetry, and negative trends in stride length, walking velocity, and
push-off impulse.
It is concluded that computer-assisted feedback is an effective
tool for retraining gait in stroke patients!
Publication Types:
| Clinical trial |
| Randomized controlled trial |
PMID: 8215864, UI: 94029516
Techniques to improve
function of the arm and hand in chronic hemiplegia.
Arch Phys Med Rehabil 1992 Mar;73(3):220-227
Kraft GH, Fitts SS, Hammond MC
Department of Rehabilitation Medicine, University of Washington, Seattle 98195.
We evaluated functional improvement in the upper limb of chronic (more than six months' duration) stroke patients who received one of two electrical stimulation treatments, conventional treatment, or no treatment. Twenty-two right-handed patients were assigned to one of four groups studied for 12 months posttreatment. Subjects received (1) EMG-initiated electrical stimulation of wrist extensors (EMG-stim), (2) low-intensity electrical stimulation of wrist extensors combined with voluntary contractions (B/B), (3) proprioceptive neuromuscular facilitation (PNF) exercises, or (4) no treatment. Subjects were treated for three months. Before treatment, upon completion of treatment, and three and nine months after treatment, subjects were evaluated by the Fugl-Meyer (FM) poststroke motor recovery test and by grip strength. Subjects also attempted three Jebsen-Taylor hand function tests and a finger tapping test at the same evaluation sessions, but many were unable to complete these tests. During the course of treatment, FM scores of subjects receiving PNF improved 18%, B/B improved 25%, and EMG-stim improved 42%. The aggregate FM improvement of the treated groups was significant from pretreatment to posttreatment, and the improvement was maintained at three-month and nine-month followups (all p less than .005). The treated subjects' improvement in grip strength was also maintained at both followups (p less than .10). In contrast, the control group showed no significant change in FM scores or grip strength. The four treated subjects who were able to perform the hand function tests and finger tapping at all four evaluations also improved on these tests.
MeSH Terms:
| Aged |
| Arm* |
| Cerebrovascular Disorders/rehabilitation |
| Cerebrovascular Disorders/complications |
| Chronic Disease |
| Comparative Study |
| Electric Stimulation Therapy* |
| Evaluation Studies |
| Female |
| Hand* |
| Hemiplegia/rehabilitation* |
| Hemiplegia/etiology |
| Human |
| Male |
| Middle Age |
| Muscle Contraction |
| Support, Non-U.S. Gov't |
| Support, U.S. Gov't, Non-P.H.S. |
PMID: 1543423, UI: 92181302
