Frontal ataxia: historical aspects and clinical definition / Ataxia frontal: aspectos históricos e definição clínica

Abstract Frontal ataxia, originally described by Bruns, is characterized by the presence of signs of frontal lobe dysfunction, such as perseveration, paratonia, frontal release signs, cognitive changes, and urinary difficulty, associated with imbalance, slow gait, broad-based, the presence of postural instability and falls, retropulsion, and bradykinesia in the lower limbs. The goal of the present study is to recall the historical aspects of this condition, to draw attention to the importance of this clinical finding for the differential diagnosis of ataxias and to review the main semiological differences between primary ataxias (frontal, cerebellar, and sensory ataxia).

Resumo A ataxia frontal, originalmente descrita por Bruns, caracteriza-se pela presença de sinais de disfunção do lobo frontal, como perseveração, paratonia, sinais de liberação frontal, alterações cognitivas e dificuldade urinária, associados a desequilíbrio, marcha lenta, base ampla, presença de instabilidade postural e quedas, retropulsão e bradicinesia em membros inferiores. O objetivo do presente trabalho é recordar os aspectos históricos desta condição, ressaltar a importância deste achado clínico para o diagnóstico diferencial das ataxias e revisar as principais diferenças semiológicas entre as ataxias primárias (ataxia frontal, cerebelar e sensitiva).

Efecto de la retroalimentación visual sobre la velocidad de la marcha después de un accidente cerebrovascular: diseño de caso único / Effects of Visual Feedback on Walking Speed for Stroke Patients: Single-case Design

Introducción. La recuperación de la marcha es uno de los principales objetivos en rehabilitación después de un ACV. Basados en los principios de aprendizaje motor, se han desarrollado nuevas estrategias en neurorrehabilitación basadas en la práctica repetitiva, orientada a la tarea y la retroalimentación. Esto último ha demostrado ser una de las variables clave para el entrenamiento, por su fácil obtención y manipulación. Sin embargo, aún no existen estudios concluyentes que permitan identificar el efecto real de esta variable y su influencia en la recuperación y el desempeño funcional de la marcha. Objetivo. Determinar el efecto de la retroalimentación visual sobre la velocidad de la marcha después de un accidente cerebrovascular en adultos con estadios subagudos y crónicos. Metodología. Diseño de caso único de línea de base múltiple, aleatorio no concurrente de cuatro participantes. Se evaluó la velocidad de la marcha determinando las diferencias en el nivel, la tendencia, la estabilidad de los datos y la no superposición de datos mediante el análisis visual basado en la documentación técnica para diseños de caso único de la What Works Clearinghouse. Resultados. Cuatro participantes con rango de edad de 19 a 73 años fueron incluidos en el estudio. El cambio en el nivel para todos los participantes demostró un incremento en los valores de la velocidad de la marcha después de la introducción de la intervención (media: 0.76 m/s). El análisis visual de la tendencia estimó aceleración para la línea de intervención para tres participantes. Los datos en la fase de base e intervención cumplieron el criterio de estabilidad medido con el método de banda de dos desviaciones estándar (media: 0.05 m/s); los patrones de cambio demostraron efecto inmediato con mejoría gradual durante la intervención para los participantes 1, 3 y 4. El porcentaje de no superposición de datos mostró efectividad de la intervención para tres de los participantes (PND >91.67%). Conclusiones. Los hallazgos presentados en este estudio representan un aporte científico que respalda la pertinencia del uso y aplicación de los principios de aprendizaje motor para el desarrollo de nuevas estrategias en rehabilitación motora. Sin embargo, este estudio constituye un primer paso para realizar estudios más robustos que incluyan replicación de las fases en el estudio y la evaluación del seguimiento para determinar la permanencia de los efectos a largo plazo.

Introduction. Gait recovery is one of the main goals in post-stroke rehabilitation. Based on the principles of motor learning, new strategies have been developed in neurorehabilitation based on repetitive, task-oriented practice, and feedback. The latter has proven to be one of the most critical variables for training, because it is easy to obtain and manipulate. However, there are still no conclusive studies to identify the real effect of this variable and its influence on recovery and functional gait performance. Objective. To determine the effect of visual feedback on gait speed after stroke in adults with subacute and chronic stages.Methodology. Single-case, multiple baseline, non-concurrent randomized, and four-participant design. Gait velocity was assessed by determining differences in level, trend, data stability, and nonoverlapping data using visual analysis based on technical documentation for single-case designs from the What Works Clearinghouse.Results. Four participants ranging in age from 19 to 73 years were included in the study. The change in level for all participants demonstrated an increase in gait velocity values after the introduction of the intervention (mean: 0.76 m/s). Visual trend analysis estimated acceleration for the intervention line for three participants. The data in the baseline and intervention phase met the stability criterion measured with the two standard deviation band method (mean: 0.05 m/s); patterns of change demonstrated immediate effect with gradual improvement during the intervention for participants 1, 3, and 4. The percentage of nonoverlapping data showed effective-ness of the intervention for three of the participants (PND >91.67%).Conclusions. The findings presented in this study represent a scientific contribution that supports the relevance of the use and application of motor learning principles for the development of new strategies in motor rehabilitation. However, this study constitutes a first step towards more robust studies that include replication of the phases in the study and follow-up evaluation to determine the permanence of long-term effects.

Enriched rehabilitation improves dual-task gait disorder after a transient ischemic attack / 中华物理医学与康复杂志

Objective:To observe the effect of enriched rehabilitation on dual-task gait disorder after a transient ischemic attack (TIA) and explore its mechanism.Methods:Sixty TIA patients were randomly divided into a control group and an observation group, each of 30. Another 30 healthy counterparts were selected to form a healthy control group. All of the TIA patients were given routine medication to lower blood pressure and improve brain function, while the observation group was additionally provided with enriched rehabilitation training for 12 weeks. Before and after the intervention, the gait and cognitive functioning of all of the subjects were quantified and their event-related potentials (P300s) and serum brain-derived neurotrophic factor (BDNF) levels were also measured.Results:Before the treatment there were significant differences between the TIA groups and healthy controls in all of the measurements, but there were no significant differences between the control and observation groups. After the treatment, no significant improvement was observed in any of the control group′s results, but there was significant improvement in the observation group′s gait parameters, cognitive functioning, average serum BDNF concentration and in the average latency and amplitude of its P300 signals.Conclusions:Enriched rehabilitation can improve the gait of TIA patients, perhaps through increasing their serum BDNF concentration and improving their cognition.

Clinical value of changes of gait characteristics in the progression of Parkinson′s disease / 中华神经科杂志

Objective:To determine the evolution of gait impairment over the course of Parkinson′s disease (PD) by assessing the changes of gait characteristics in different disease stages, which could be helpful for disease monitoring.Methods:A total of 276 PD patients [PD group, Hoehn-Yahr (H-Y) stage 1-3] and 63 healthy controls (control group) enrolled in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to September 2021 were included in this cross-sectional study. The gait spatiotemporal variables were recorded by a portable inertial measurement unit system. Exploratory factor analysis was performed to obtain gait domains representing different gait characteristics. One way analysis of variance was used to evaluate the differences of gait variables and gait domains among the control group and 3 different H-Y stages of the PD group, as well as the differences among the control group and 2 motor subtypes of PD in different stages. The sensitivity of different gait variables and gait domains in evaluating the severity of gait impairments at different disease stages was compared.Results:Eleven gait spatiotemporal variables were grouped in 4 gait domains: pace (step length, gait speed and stride length), rhythm/phase (cadence, stride time and double support time), pace-related variability/asymmetry [step length coefficient of variation (CV), gait speed CV and step length asymmetry] and rhythm/phase-related variability/asymmetry (swing time CV and swing time asymmetry). As the disease progresses, most evolution trends of the 4 gait domains in the tremor-dominant PD patients were consistent with those in the non-tremor-dominant subtype. Compared with the control group, PD patients at H-Y stage 1 began to show the mild impairment of rhythm/phase-related variability/asymmetry (effect size 0.42; standardized score -0.03±0.69 vs -0.33±0.49, P<0.05), especially swing time asymmetry in tremor-dominant patients; the pace domain was damaged moderately in PD patients at H-Y stage 2 (effect size 0.64; standardized score 0.12±0.80 vs 0.64±0.81, P<0.05), especially in non-tremor-dominant PD patients, but not in PD patients at H-Y stage 1 ( P>0.05). Pace-related variability/asymmetry showed great impairment in PD patients at H-Y stage 3 (effect size 0.62; standardized score 0.27±1.12 vs -0.27±0.52, P<0.05), but not in PD patients at H-Y stages 1 and 2 ( P>0.05). Conclusions:The characteristic impairments of gait in PD evolve in the process of disease progression. The rhythm/phase-related variability/asymmetry domain may be a marker to distinguish early PD from healthy controls. The pace domain and the pace-related variability/asymmetry domain are important markers to evaluate the progression of PD.

Research progress of Parkinson's frozen gait / 中国医师杂志

Parkinson's disease is a neurodegenerative disease characterized by static tremor, myoto-nia, motor retardation and abnormal posture and gait. Freezing of gait ( FOG) is a common symptom of ad-vanced Parkinson's disease. At present, the pathogenesis of frozen of gait is not clear, and treatment is still difficult. This article reviews the latest progress and treatment of frozen gait in Parkinson's disease patients and makes a prospect.

Hidrocefalia De Presión Normal / Normal Pressure Hydrocephalus

Resumen La hidrocefalia de presión normal es una patología reversible que forma parte de las demencias. A pesar del tiempo que ha transcurrido desde su descubrimiento, su fisiopatología no ha sido claramente establecida y se han planteado dos teorías que buscan explicar el proceso. Una está basada en cambios en el flujo de líquido cefalorraquideo y la otra en el flujo sanguíneo cerebral. Además, el proceso de evaluación y diagnóstico no está determinado, puesto que no existe un método estándar y los síntomas son similares a otras patologías de sistema nervioso central, haciendo que el diagnóstico se realice gracias a la suma de los síntomas clínicos y ciertos hallazgos imagenológicos que no son siempre constantes.

Abstract Normal pressure hydrocephalus is a pathology causing dementia that is reversible. Despite the time elapsed since its discovery, its pathophysiology has not been clearly established and two theories have been proposed that try to explain the process, one based on changes in cerebrospinal fluid flow and the other on cerebral blood flow. In addition, the evaluation and diagnosis process is not determined, since there is no standard method and the symptoms are similar to other pathologies of the central nervous system, leading to the diagnosis as the summation of clinical symptoms and some findings in imaging which are not always constant.

Acute necrotising encephalopathy of childhood: A review of two cases

Acute necrotising encephalopathy of childhood (ANEC) is an uncommon disease with characteristic clinical and imaging findings. We present two cases of ANEC secondary to Respiratory Syncytial Virus (RSV) and mycoplasma infections. An eight-month-old boy presented with features of gastroenteritis but soon developed multiple episodes of seizures. Blood and CSF cultures were negative but nasopharyngeal aspirate immunofluorescence was positive for RSV. A nine-year-old girl presented with abnormal behaviour following two days of prodromal symptoms. Her serological markers implicated mycoplasma (IgM titre 1: 640). CT brain of both patients showed bilateral symmetrical thalamic hypodensities, while MRI revealed more extensive white matter involvements.

Clinical observation of polysomnographic in patients with different subtypes of Parkinson's disease / 临床神经病学杂志

Objective To evaluate the changes parameters of polysomnographic ( PSG) with different subtypes of primary Parkinson's disease ( PD ) and analyze the clinical characteristics of sleep disorders in PD patients. Methods Ninety patients with primary PD [ tremor-predominant PD group ( n = 40 ) , postural instability gait disorder ( PIGD )-predominant PD group ( n = 50 ) ] and 50 healthy controls were detected by full night PSG monitoring. And the results were compared. Results Compared with tremor-predominant PD group, the total sleep time, bed time, sleep wake-up times, sleep efficiency and rapid eye movement ( REM ) sleep time of PIGD-predominant PD group were significantly lower (all P0. 05). Compared with the controls, the total sleep time and bed time of tremor-predominant PD group were significantly lower (all P0. 05). Combined with video surveillance video observation,the abnormality of REM sleep behavior disorder ( RBD) was 70% with PIGD-predominant PD group, in which the abnormality of tremor-predominant PD group was 2. 5%. Conclusions The PIGD-predominant PD patients are more likely to appear sleep disorders and RBD than tremor-predominant PD patients. It may be related to clinical heterogeneity of different PD subtypes.

Clinical Characteristics of Proper Robot-Assisted Gait Training Group in Non-ambulatory Subacute Stroke Patients

OBJECTIVE: To identify the clinical characteristics of proper robot-assisted gait training group using exoskeletal locomotor devices in non-ambulatory subacute stroke patients. METHODS: A total of 38 stroke patients were enrolled in a 4-week robotic training protocol (2 sessions/day, 5 times/week). All subjects were evaluated for their general characteristics, Functional Ambulatory Classification (FAC), Fugl-Meyer Scale (FMS), Berg Balance Scale (BBS), Modified Rankin Scale (MRS), Modified Barthel Index (MBI), and Mini-Mental Status Examination (MMSE) at 0, 2, and 4 weeks. Statistical analysis were performed to determine significant clinical characteristics for improvement of gait function after robot-assisted gait training. RESULTS: Paired t-test showed that all functional parameters except MMSE were improved significantly (p<0.05). The duration of disease and baseline BBS score were significantly (p<0.05) correlated with FAC score in multiple regression models. Receiver operating characteristic (ROC) curve showed that a baseline BBS score of '9' was a cutoff value (AUC, 0.966; sensitivity, 91%-100%; specificity, 85%). By repeated-measures ANOVA, the differences in improved walking ability according to time were significant between group of patients who had baseline BBS score of '9' and those who did not have baseline BBS score of '9' CONCLUSION: Our results showed that a baseline BBS score above '9' and a short duration of disease were highly correlated with improved walking ability after robot-assisted gait training. Therefore, baseline BBS and duration of disease should be considered clinically for gaining walking ability in robot-assisted training group.

Relationships among measures of gait recovery and community integration index in people with brain injury / 中国基层医药

Objective To examine the relationships among measures of gait recovery and community integra-tion index in people with brain injury.Methods 142 brain injured patients were chosen in this study.Community Balance and Mobility Scale,Dynamic Gait Index,Ten-Meter Walk Test for gait speed,and the Community Integration Questionnaire (CIQ) was measured.Results Average walk speed was 0.31-5.30 (1.36 ±0.88)m/s;DGI score was 5-24 (18.6 ±5.44) points;CMBS score was 0 -96 (54.1 ±25.3) points;CIQ subscale 6 -29 (16.2 ± 5.1)points,CIQ family subscale was 0-10 (4.8 ±3.0)points;CIQ society subscale was 4-12(8.2 ±2.1)points;CIQ productivity subscale was 0-7(3.8 ±2.2).The correlation between age and Ten-Meter Walk Test was nega-tive significantly (r=-0.50,P<0.05).All 3 balance/gait measures correlated significantly with the CIQ Productiv-ity subscale (r=0.35-0.58,P<0.05).Conclusion The ability of people with brain injury to engage in work/school/volunteer activity may be reduced by impairments in balance and mobility.

Correlation between plantar pressure and walking ability in hemiplegic stroke survivors / 中华物理医学与康复杂志

Objective To explore the correlation between plantar pressure and walking function in hemiplegic stroke patients.Methods Thirty hemiplegic patients with stroke (a hemiplegic group) and thirty age-matched healthy persons (a control group) were recruited.Gait and balance function training and assessment system (model:AL-600) were used to quantify the walking velocity,peak plantar pressure at heel-strike and push-off periods and displacement of center of pressure (DCOP) of all subjects during walking.The asymmetry of gait was calculated.Two independent sample t-test were used to compare the walking velocity,peak plantar pressure and DCOP for the two groups.Pearson correlation coefficients were applied to analyze the correlation between the walking velocity and peak plantar pressure and DCOP.Results The walking velocity,the peak plantar pressure at heel-strike and push-off periods and DCOP of the hemiplegic group were significantly lower than the control group.In the hemiplegic group,the asymmetry of peak plantar pressure and DCOPx significantly increased,while that of DCOPy became bigger without significant difference.Moreover,the walking capacity of the hemiplegic group was positively correlated with the peak plantar pressure and DCOP.Conclusion Among hemiplegic stroke patients,both the peak plantar pressure at heel-strike and push-off periods lower in a way.Their capacity of weight transfer decreases,which is closely related to their walking velocity.

Cerebrospinal Fluid Tap Test in Idiopathic Hydrocephalus Patient with an Evans' Index Less Than 0.3

A 73-year-old man presented with progressive gait impairment. He exhibited slow, shuffling, and unstable gait. A formal neuropsychological evaluation revealed memory deficits with frontal dysfunction. Brain MRI revealed communicating hydrocephalus with an Evans' index of 0.27. After cerebrospinal fluid (CSF) removal by lumbar puncture, the patient exhibited a marked improvement in gait. A CSF tap test after careful clinical examination may need to be considered in the diagnosis of idiopathic hydrocephalus with an Evans' index of <0.3.

Relationship between cognitive impairment and the other clinical features of subcortical damage in patients with subcortical ischemic vascular disease / 中华老年医学杂志

Objective To investigate the relationship between cognitive impairment and the other clinical features of subcortical damage in patients with magnetic resonance imaging(MRI)-defined subcortical ischemic vascular disease(SIVD).Methods The cohort for this study included 110 SIVD patients who were divided into 3 groups according to cognitive status:patients with noncognition impairment(SIVD-NCI group,n=34),patients with mild cognitive impairment(SIVD-MCI group,n =47) and patients with vascular dementia (SIVD-VaD group,n =29).The cognitive functions were evaluated by the mini-mental state examination (MMSE) and Montreal cognitive assessment(MoCA),the Cambridge cognitive examination-Chinese version(CAMCOG-C),activity of daily living scale(ADL) and clock drawing task(CDT),etc.Depression symptoms were assessed by the geriatric depression scale (GDS),while the other clinical features of subcortical damage were assessed by the timedGet-Up and Go test,etc.Results There were statistically significant differences in the MMSE,MoCA,CAMCOG-C,CDT and ADL scores among the three groups(H=85.36,F=50.32,55.03,H=27.39,40.87,respectively,all P＜0.05).Gait disturbance,urinary disorder,pseudobulbar palsy,depression and falls were statistically significantly different among the threegroups(x2=21.69,21.41,25.51,6.91,21.87,all P＜0.05).In addition,gait disturbance was increasingly aggravated with the severity of cognitive impairment.In SIVD-MCI group,urinary disorder,pseudobulbar palsy and falls were significantly increased as compared with SIVD-NCI group (x2 =15.57,16.31,8.92,both P＜0.017).Depression was statistically significant different between SIVD-NCIandSIVD-VaD group(x2 =6.90,P＜0.017).Among the three groups,there was no significant difference in the feature of emotional incontinence.Conclusions With the decline in cognitive function,the patients with SIVD can present with different clinical features of subcortical damage.Gait disturbance is gradually aggravated with the decline in cognitive function.Urinary disorder,pseudobulbar palsy,and falls can reflect the cognitive impairment from normal to mild on the other hand.Depression can be used as one of the signs that show cognitive impairment reached to dementia.

Idiopathic Normal-Pressure Hydrocephalus Patient With an Ataxic Gait as the Predominant Presenting Manifestation

A 43-year-old man presented with progressive ataxic gait of 5 months duration. His gait speed was almost normal, and he did not exhibit shuffling, freezing, or festination. A formal neuropsychological evaluation revealed a deficit in visuospatial function and memory with mild frontal dysfunctions. Brain MRI revealed communicating hydrocephalus with an Evans' ratio of 0.32. After CSF removal by lumbar puncture the patient showed a marked improvement in gait as well as frontal lobe functions, and was finally diagnosed as having idiopathic normal-pressure hydrocephalus.

Gait analysis in cerebral palsy children / 中国组织工程研究

BACKGROUND:Abnormal gaits are very common in children with cerebral palsy, and how to improve the gait is the focus of rehabilitation therapy. OBJECTIVE:To analyze the biomechanical parameters of gaits in cerebral palsy children and to observe the effects of brace control on the exercise capacity of dyskinetic cerebral palsy children. METHODS:In this paper, we compared the biomechanical parameters of children with cerebral palsy and normal children in the initial process of walking and during walking. Biomechanical parameters in the initial process of walking include spatial and temporal parameters, kinematic and kinetic parameters of the range of motion of the knee and ankle. Biomechanical parameters during walking include spatial and temporal parameters. With the aid of hand brace, dyskinetic cerebral palsy received postural control, gait training, and sling exercise therapy for 3 months. The Gross Motor Function Measure (GMFM-88) assessment and video control were conducted for evaluation of therapeutic efficiency. RESULTS AND CONCLUSION:Biomechanical parameters in the initial process of walking showed significant differences between children with cerebral palsy and normal children except for the peak of ground reaction force at frontal axis with the right foot to start walking. Biomechanical parameters during walking showed that the stance phase and bipedal stance phase were prolonged, while the step length and stride length were shortened in the children with cerebral palsy compared with the normal children. For cerebral palsy children with brace control, the GMFM-88 scores were significantly decreased after treatment, involuntary movements were reduced shown on the video, the neck and body were stable, and life skil s were improved. Children with epilepsy and cognitive impairment or who had imaging changes in the basal ganglia showed a little improvement, and children with dance-athetoid type and dystonia type had a better progress than those with athetoid spasm.

Ataxia aguda em idade pediátrica? revisão retrospectiva de cinco anos / Acute ataxia in childhood? a five year retrospective review

Objetivos: Caracterizar os casos de ataxia aguda internados em um Serviço de Pediatria e avaliar a sua abordagem no Departamento de Urgência.Métodos: Análise retrospectiva dos registos clínicos das crianças internadas entre janeiro de 2006 e dezembro de 2010 com quadro clínico de alteração da marcha e/ou dos movimentos motores finos com início dentro das últimas 72 horas.Resultados: Foram incluídas 82 crianças, 44 do sexo feminino. A mediana de idade foi de 4 anos. Trinta crianças apresentaram pródromos e 18 tinham história de infecção prévia. Os sintomas concomitantes mais frequentes foram sonolência (46 casos), vômitos (18 casos) e irritabilidade (14 casos). O exame físico não mostrou alterações em dois terços dos casos. Setenta crianças foram sujeitas a pelo menos um exame complementar de diagnóstico. As principais causas identificadas foram intoxicações (53 casos) e ataxia pós-infecciosa (15 casos). Só 16% necessitaram de tratamento específico e a maioria das internações foi de curta duração. Foram referenciados para seguimento em consulta hospitalar 32 casos. Registrou-se uma evolução benigna na maioria dos casos.Conclusões: A atitude face a uma criança com ataxia aguda deve ser ponderada e individualizada, tornando-se difícil a implementação de um protocolo de abordagem uniforme. A maioria dos casos tem um curso benigno e autolimitado, com internação de curta duração e apenas tratamento de suporte. No entanto, causas mais graves devem ser devidamente excluídas. História clínica minuciosa, exame físico e neurológico completos e internação visando a vigilância da evolução clínica são aspectos fundamentais.

Aims: To characterize the cases of acute ataxia hospitalized in a Pediatric Department and to evaluate its approach in the Emergency Department.Methods: Retrospective analysis of medical records of children admitted between January 2006 and December 2010 with clinical gait and/or fine motor movements with onset within the last 72 hours.Results: We included 82 children, 44 girls. The median age was 4 years. Thirty children had prodromes and 18 had a history of previous infection. The most frequent accompanying symptoms were somnolence (46 cases), vomiting (18 cases) and irritability (14 cases). Physical examination showed no changes in two thirds of cases. Seventy children have been subjected to at least one further diagnostic examination. The main causes were poisoning (53 cases) and post-infectious ataxia (15 cases). Only 16% needed specific treatment and most admissions were of short duration. Thirty-two cases were referred for follow-up consultation. The course was benign in most cases.Conclusions: The attitude towards a child with acute ataxia should be careful and individualized, making it difficult to implement a uniform protocol for approach. Most cases have a benign and self-limiting course, with short duration admission and only supportive care. However, serious causes must be properly excluded. Detailed clinical history, complete physical and neurological examination, and hospitalization for monitoring of clinical course are crucial.

The effects of walking training assisted by electromyographic biofeedback on motor recovery of the lower limb of subacute stroke patients with foot drop / 中华物理医学与康复杂志

Objective To explore the effects of walking training assisted by electromyographic biofeedback (EMGBF) on the lower limb function of subacute stroke patients with foot drop. Methods Forty subacute stroke patients with foot drop were randomly divided into an EMGBF training group (n =20 ) and a routine rehabilitation training group ( n =20 ).Both groups received routine rehabilitation training.The EMGBF training group also received walking training assisted by three stages of EMGBF.The subjects were treated for 40 min twice per day,5 days a week for 6 weeks.Clinical and functional evaluations such as surface electromyogram (sEMG) signals from the anterior tibial muscle,active ankle dorsiflexion range of motion ( AROM ),scores on the modified Ashworth scale (MAS),results of the modified Lovett manual muscle test (mMMT),pace and step length,Berg balance scale (BBS) scores,Fugl-Meyer movement function scale (FMA) assessments,modified Barthel index (MBI) scores and Holden walking function test results were observed before treatment,after 6 weeks of treatment and at follow-up 6 weeks after the end of treatment. Results Before treatment there was no significant difference between the two groups.There were significant differences in all of the assessment results in the EMGBF training group after treatment compared with before treatment and compared with the routine rehabilitation training group after treatment.At followup 6 weeks after training,average pace (69.75 ± 35.09 m/min),step length (60.98 ± 14.09 cm),FMA score (32.5 ± 6.34 ) and MBI score (88.65 ± 14.13 ) in the EMGBF training group were all significantly better than in the routine rehabilitation group.At follow up,5 patients in the EMGBF training group achieved grade 5 in the Holden walking function test versus only 1 patient in the routine rehabilitation group. Conclusion Walking training assisted by EMGBF is effective in improving lower limb motor function in subacute stroke patients with foot drop.

Piriformis Syndrome in Knee Osteoarthritis Patients after Wearing Rocker Bottom Shoes

BACKGROUND: Rocker bottom shoes (RBS) are popular among patients with different foot, leg, or back problems in Korea. Patients with knee osteoarthritis concurrent weakness in the quadriceps femoris muscle, who wear these shoes, are often assumed to develop piriformis syndrome (PS). This study was performed to improve the understanding about the effect of wearing such shoes on duration of the syndrome in knee osteoarthritis. METHODS: We randomly assigned 150 patients with PS, who had used RBS daily for at least 6 months, to 2 groups, the S (stopped wearing) and K (kept wearing) groups. Both the groups were subdivided into the O and N groups, comprising patients with and without knee osteoarthritis, respectively. The effects of the treatment, including piriformis muscle injections and a home exercise program, were compared between the 2 groups by using a flexion-adduction-internal rotation (FAIR) test, a numeric rating scale (NRS), and the revised Oswestry disability index (ODI) during the 12-week follow-up. RESULTS: The positive FAIR test ratios, mean NRS scores, and revised ODIs were higher in the KO group than the SN group from 4?12 weeks after treatment. CONCLUSIONS: RBS may extend duration of the PS in osteoarthritis patients.

Gait disorders in patients with subcortical ischemic vascular disease / 国际脑血管病杂志

Subcortical ischemic vascular disease (SIVD) is a group of ischemic cerebrovascular diseases caused by small-vessel disease,and the major pathological damage is multiple subcortical lacunar infarction and white matter lesions.SIVD is the most major cause of resulting in vascular cognitive impairment.It can also have gait disorders,such as Parkinsonlike gait,frontal gait,ataxia,or frequent fall without obvious inducement,etc.Several studies have shown that the gait abnormalities in the elderly may be the early signs of vascular dementia.This article reviews SIVD caused pathomechanisms,clinical features,clinical significance,analysis and evaluation and treatment of gait disorders.

Perda da voz em professores e não professores / Voice loss in teachers and non-teachers

OBJETIVO: Verificar a percepção de professores e não-professores sobre as implicações de uma eventual perda de voz. MÉTODOS: Participaram 205 indivíduos sendo 105 professores e 100 não professores entre 23 a 65 anos, 106 mulheres e 99 homens. Foi aplicado um questionário contendo quatro perguntas referentes a uma eventual perda de visão, audição, voz e deambulação e o grau de impacto inferido (de 0 a 4). RESULTADOS: Para o grupo de professores, não enxergar gerou o maior impacto negativo (média de 3,8), seguido por não andar (média de 3,7), não ter voz (média de 3,7) e não ouvir (média de 3,6). Para o grupo de não-professores, não enxergar também gerou o maior impacto negativo (média de 3,4), seguido por não andar (média de 3,0); não ouvir (média de 2,2) e não ter voz (média de 2,0). Em relação ao maior impacto de uma eventual perda da voz, professores indicaram prejuízos no trabalho, relacionamento social e atividades rotineiras e, no grupo de não professores, nas atividades rotineiras, trabalho, relacionamento social e manifestações das emoções. CONCLUSÕES: Os professores valorizam sua voz de modo diverso dos não-professores e ambos os grupos avaliam a perda da voz como algo que não acarreta consequências negativas. Apesar de o professor perceber mais o impacto de um eventual problema de voz do que o não-professor, os sentimentos em relação à perda da voz foram muito semelhantes nos dois grupos.

PURPOSE: To investigate teachers' and non-teachers' perception regarding the implications of an eventual loss of voice. METHODS: Participated in the study 205 individuals (106 women and 99 men), 105 teachers and 100 non-teachers, with ages varying from 23 to 65 years old. The participants were asked to answer a questionnaire with four questions regarding an eventual loss of vision, hearing, voice and deambulation, and the inferred impact degree (from 0 to 4). RESULTS: For the teachers group, not being able to see caused the most negative impact (mean of 3.8), followed by not being able to walk (mean of 3.7), loss of voice (mean of 3.7) and hearing loss (mean of 3.6). For the non-teachers group, loss of sight also caused the most negative impact (mean of 3.4), followed by not being able to walk (3.0), hearing loss (2.2), and loss of voice (2.0). Regarding the impact of an eventual voice loss, the teachers group indicated negative consequences at work, in their social relationships and in their daily routines. The non-teachers group indicated negative consequences to their daily routine, at work, in their social relationships and in their emotional manifestations. CONCLUSION: The teachers showed to value their voices differently from the non-teachers group. Both groups agreed that voice loss would not bring the most negative consequences. Although teachers noticed more the impact of an eventual loss of voice than non-teachers, the feelings towards this hypothetical situation were similar in both groups.