Kinect-based rapid movement training to improve balance recovery for stroke fall prevention: a randomized controlled trial.

BACKGROUND: Falls are more prevalent in stroke survivors than age-matched healthy older adults because of their functional impairment. Rapid balance recovery reaction with adequate range-of-motion and fast response and movement time are crucial to minimize fall risk and prevent serious injurious falls when postural disturbances occur. A Kinect-based Rapid Movement Training (RMT) program was developed to provide real-time feedback to promote faster and larger arm reaching and leg stepping distances toward targets in 22 different directions. OBJECTIVE: To evaluate the effectiveness of the interactive RMT and Conventional Balance Training (CBT) on chronic stroke survivors' overall balance and balance recovery reaction. METHODS: In this assessor-blinded randomized controlled trial, chronic stroke survivors were randomized to receive twenty training sessions (60-min each) of either RMT or CBT. Pre- and post-training assessments included clinical tests, as well as kinematic measurements and electromyography during simulated forward fall through a "lean-and-release" perturbation system. RESULTS: Thirty participants were recruited (RMT = 16, CBT = 14). RMT led to significant improvement in balance control (Berg Balance Scale: pre = 49.13, post = 52.75; P = .001), gait control (Timed-Up-and-Go Test: pre = 14.66 s, post = 12.62 s; P = .011), and motor functions (Fugl-Meyer Assessment of Motor Recovery: pre = 60.63, post = 65.19; P = .015), which matched the effectiveness of CBT. Both groups preferred to use their non-paretic leg to take the initial step to restore stability, and their stepping leg's rectus femoris reacted significantly faster post-training (P = .036). CONCLUSION: The RMT was as effective as conventional balance training to provide beneficial effects on chronic stroke survivors' overall balance, motor function and improving balance recovery with faster muscle response. TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov ( https://clinicaltrials.gov/ct2/show/NCT03183635 , NCT03183635) on 12 June 2017.

Influence of Sport Type on Metatarsophalangeal and Ankle Joint Stiffness and Hopping Performance.

While individual ankle and metatarsophalangeal joint stiffness is related to training intensity and sport performances, sport athletes may develop specific passive joint stiffness among the spectrum from endurance to powerful types of sports. The objective of this study examined whether marathon runners, basketball players, and other sports athletes would demonstrate distinct passive ankle and metatarsophalangeal joint stiffness as well as vertical stiffness. Fifteen marathon runners, nineteen basketball players, and seventeen other sports athletes performed both joint stiffness measurement and single-leg hopping tests. We used a computerized dynamometer to control foot alignment and speed for passive ankle and metatarsophalangeal joint stiffness measurements. We calculated vertical stiffness by body deceleration and body mass displacement during hopping on the force platform. One-way ANOVA was performed to identify the group differences. Bivariate correlation test was also performed among ankle, metatarsophalangeal, and vertical stiffness. The basketball group displayed 13% higher ankle passive stiffness than the other sports players group (P = 0.03). Metatarsophalangeal joint passive stiffness in sitting and standing positions was 23% higher in the basketball group than the runner and other sports athlete groups (P < 0.01). However, there was no significant group differences in metatarsophalangeal joint passive stiffness and vertical stiffness. Significant correlations among all stiffness variables were determined (P < 0.05). These findings indicate that ankle and metatarsophalangeal joint passive stiffness, rather than vertical leg stiffness, would be in relation to types of sports participation. Ankle and toe strengthening exercises could improve basketball players' performance and prevent injury.

Is passive metatarsophalangeal joint stiffness related to leg stiffness, vertical stiffness and running economy during sub-maximal running?

This study examined whether passive metatarsophalangeal joints (MPJ) stiffness was associated with leg stiffness (Kleg) vertical stiffness (Kvert) and running economy (RE) during sub-maximal running. Nine male experienced runners underwent passive MPJ stiffness measurements in standing and sitting positions followed by sub-maximal running on an instrumented treadmill. With the individual foot position properly aligned, the MPJ passive stiffness in both sitting (MPJsit) and standing positions (MPJstand) were measured with a computerized dynamometer. Data were collected at a running speed of 2.78m/s, representing a stabilized level of energy expenditure. Pedar pressure insole was used to determine the contact time (tc) and peak reaction force for the calculation of Kleg and Kvert. A respiratory gas analysis system was used to estimate the RE. Bivariate correlation test was performed to examine the correlation among MPJ stiffness, contact time, Kleg, Kvert, and RE. The results showed that MPJsit and MPJstand were inversely correlated with RE (p=0.04, r=-0.68 to -0.69), suggesting that stiffer MPJ improves RE. In addition, MPJsit was correlated positively with Kleg (p<0.01, r=0.87),Kvert (p=0.03, r=0.70) but inversely with tc (p=0.02, r=-0.76), while MPJstand was correlated positively with the Kvert (p=0.02, r=0.77). These findings suggested that strength of toe plantar flexors provides stability and agility in the stance phase for more effective and faster forward movement.

Reliability of metatarsophalangeal and ankle joint torque measurements by an innovative device.

The toe flexor muscles maintain body balance during standing and provide push-off force during walking, running, and jumping. Additionally, they are important contributing structures to maintain normal foot function. Thus, weakness of these muscles may cause poor balance, inefficient locomotion and foot deformities. The quantification of metatarsophalangeal joint (MPJ) stiffness is valuable as it is considered as a confounding factor in toe flexor muscles function. MPJ and ankle joint stiffness measurement is still largely depended on manual skills as current devices do not have good control on alignment, angular joint speed and displacement during measurement. Therefore, this study introduces an innovative dynamometer and protocol procedures for MPJ and ankle Joint torque measurement with precise and reliable foot alignment, angular joint speed and displacement control. Within-day and between-day test-retest experiments on MPJ and ankle joint torque measurement were conducted on ten and nine healthy male subjects respectively. The mean peak torques of MPJ and ankle joint of between-day and within-day measurement were 1.50±0.38Nm/deg and 1.19±0.34Nm/deg. The corresponding torques of the ankle joint were 8.24±2.20Nm/deg and 7.90±3.18Nm/deg respectively. Intraclass-correlation coefficients (ICC) of averaged peak torque of both joints of between-day and within-day test-retest experiments were ranging from 0.91 to 0.96, indicating the innovative device is systematic and reliable for the measurements and can be used for multiple scientific and clinical purposes.

Executive function deficits and neural discordance in children with Autism Spectrum Disorders.

OBJECTIVE: This study examined neurophysiologic activities, executive dysfunctions, and their association in children with Autism Spectrum Disorders (ASD). METHODS: Thirty-eight normal and 16 children with ASD participated with parental consent. Executive functions were measured using neuropsychological tests and parent ratings, and neurophysiologic activities were measured using EEG to yield cordance values, an indirect measure of brain perfusion. RESULTS: Children with ASD made significantly more intrusion errors and False Alarms on the Hong Kong List Learning Test (HKLLT) and Object Recognition Test (OR) than normal children, but were comparable to normal children on the Rey-Osterrieth Complex Figure Test and Continuous Performance Test. They also showed significantly poorer executive functions in everyday activities as shown on the Behavior Rating Inventory of Executive Function (BRIEF), and had lower frontal perfusion patterns than normal children as shown in the neurophysiologic cordance measures. Frontal cordance values were found to be significantly associated with executive dysfunctions in HKLLT Delayed Intrusions, OR False Alarms and BRIEF. CONCLUSIONS: Children with ASD were impaired in everyday executive functioning and response inhibition. The cordance value, which has been shown to correlate with brain perfusion in a number of studies, was significantly correlated with executive dysfunctions. SIGNIFICANCE: Exploration of this measure as an index for response to intervention is warranted.