Mirror Writing after Thalamic Hemorrhagic Stroke: A Case Report

Mirror-writing is the process of reversing individual letter and composing word sequence in opposite direction. Unintentional mirror writing has been observed in young children learning to write and interpreted as the manifestation of different cognitive impairments. It is very rare that normal right-handed adult shows mirror writing. However, the acquired "mirror writing" may be shown in left hemispheric stroke, neurodegenerative disease, and diffuse cerebral disorders. To explain this event, some assumption have been indicated such as the motor, the visual dominance, the supplementary motor area, the visio-spatial, the visual word-form, the hemispatial factor or directional and the reflected graphemic representation hypotheses. It is reported that the lesions which causes the "Mirror-writing" are the parietal lobe, basal ganglia, thalamus and right supplementary motor area, etc. We reported a case of "mirror-writing" with left thalamic hemorrhagic stroke.

Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients

OBJECTIVE: To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients. METHODS: Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted walking on the treadmill with the same body support in random order. The contact area, contact pressure, trajectory length of center of pressure (COP), temporal data on both limbs and asymmetric index of both limbs were obtained during both walking conditions, using the F-Scan in-shoe pressure measurement system. RESULTS: The contact area of midfoot and total foot on the affected side were significantly increased in robotic-assisted walking as compared to unassisted walking (p<0.01). The contact pressure of midfoot and total foot on affected limbs were also significantly increased in robotic-assisted walking (p<0.05). The anteroposterior and mediolateral trajectory length of COP were not significantly different between the two walking conditions, but their trajectory variability of COP was significantly improved (p<0.05). The asymmetric index of area, stance time, and swing time during robotic-assisted walking were statistically improved as compared with unassisted walking (p<0.05). CONCLUSION: The robotic-assisted walking may be helpful in improving the gait stability and symmetry, but not the physiologic ankle rocker function.

Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients

OBJECTIVE: To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients. METHODS: Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted walking on the treadmill with the same body support in random order. The contact area, contact pressure, trajectory length of center of pressure (COP), temporal data on both limbs and asymmetric index of both limbs were obtained during both walking conditions, using the F-Scan in-shoe pressure measurement system. RESULTS: The contact area of midfoot and total foot on the affected side were significantly increased in robotic-assisted walking as compared to unassisted walking (p<0.01). The contact pressure of midfoot and total foot on affected limbs were also significantly increased in robotic-assisted walking (p<0.05). The anteroposterior and mediolateral trajectory length of COP were not significantly different between the two walking conditions, but their trajectory variability of COP was significantly improved (p<0.05). The asymmetric index of area, stance time, and swing time during robotic-assisted walking were statistically improved as compared with unassisted walking (p<0.05). CONCLUSION: The robotic-assisted walking may be helpful in improving the gait stability and symmetry, but not the physiologic ankle rocker function.

Effects of Ankle Foot Orthosis on Post-stroke Hemiplegic Gait -A Meta-analysis-

OBJECTIVE: The aim of this meta-analysis was to investigate the effects of ankle foot orthosis on adult post-stroke hemiplegic patients' walking ability and pattern. METHOD: We searched for the case controlled clinical trials about the effects of ankle foot orthosis (AFO) for walking ability and pattern using quantitative gait analysis in adult post-stroke patients, which published between January 1950 and July 2012 in PubMed, and searching engine of Journal of Korean Academy of Rehabilitation Medicine. The mean standardized difference (MSD) and a 95% confidence interval (CI) were estimated for gait ability and pattern using fixed effect models. RESULTS: Sixteen of the 56 articles were included in this analysis. The selected studies involved a total of 274 patients. The walking speed, cadence, the portion of double limb supporting, stride length on affected side, the portion of swing period on unaffected side, and symmetry of swing period were improved by AFO. The oxygen cost was decreased by AFO. The AFO did improve ankle dorsiflexion at initial contact, maximal ankle dorsiflexion at swing phase, but the ankle plantar flexion at push-off did not. CONCLUSION: The ankle foot orthosis has some evidence to improve the walking ability and gait pattern in post-stroke hemiplegic patients.