Improving old tricks as new: Young adults learn from repeating everyday activities.

The notion that young healthy adults can substantially improve in activities that are part of their daily routine is often overlooked because it is assumed that such activities have come to be fully mastered. We followed, in young healthy adults, the effects of repeated executions of the Timed-Up-and-Go (TUG) task, a clinical test that assesses the ability to execute motor activities relevant to daily function-rising from a seated position, walking, turning and returning to a seated position. The participants (N = 15) performed 18 consecutive trials of the TUG in one session, and were retested on the following day and a week later. The participants were video recorded and wore inertial measurement units. Task execution times improved robustly; performance was well fitted by a power function, with large gains at the beginning of the session and nearing plateau in later trials, as one would expect in the learning of a novel task. Moreover, these gains were well retained overnight and a week later, with further gains accruing in the subsequent test-sessions. Significant intra-session and inter-session changes occurred in step kinematics as well; some aspects underwent inter-sessions recalibrations, but other aspects showed delayed inter-session changes, suggesting post-practice memory consolidation processes. Even common everyday tasks can be improved upon by practice; a small number of consecutive task repetitions can trigger lasting gains in young healthy individuals performing highly practiced routine tasks. This new learning in highly familiar tasks proceeded in a time-course characteristic of the acquisition of novel 'how to' (procedural) knowledge.

Decreased homotopic functional connectivity in traumatic brain injury.

INTRODUCTION: Homotopic functional connectivity (HoFC), the synchrony in activity patterns between homologous brain regions, is a fundamental characteristic of resting-state functional connectivity (RsFC). METHODS: We examined the difference in HoFC, computed as the correlation between atlas-based regions and their counterpart on the opposite hemisphere, in 16 moderate-severe traumatic brain injury patients (msTBI) and 36 healthy controls. Regions of decreased HoFC in msTBI patients were further used as seeds for examining differences between groups in correlations with other brain regions. Finally, we computed logistic regression models of regional HoFC and fractional anisotropy (FA) of the corpus callosum (CC). RESULTS: TBI patients exhibited decreased HoFC in the middle and posterior cingulate cortex, thalamus, superior temporal pole, and cerebellum III. Furthermore, decreased RsFC was found between left cerebellum III and right parahippocampal cortex and vermis, between superior temporal pole and left caudate and medial left and right frontal orbital gyri. Thalamic HoFC and FA of the CC discriminate patients as msTBI with a high accuracy of 96%. CONCLUSION: TBI is associated with regionally decreased HoFC. Moreover, a multimodality model of interhemispheric connectivity allowed for a high degree of accuracy in disease discrimination and enabled a deeper understanding of TBI effects on brain interhemispheric reorganization post-TBI.

Development of a prediction model for ascent and descent staircase independence during the sub-acute rehabilitation phase in individuals post-stroke.

BACKGROUND: Nearly half of individuals post-stroke are dependent in their daily activities. The ability to ascend and descend stairs is an important component of independence in the community. OBJECTIVE: To predict the future ability of post-stroke individuals at the beginning of the sub-acute rehabilitation phase to achieve ascending and descending staircase independence. METHODS: 36 participants were recruited for the study. OUTCOME MEASURES: independence in ascending and descending stairs up to the end of the sub-acute rehabilitation phase. Predictive measures included the knee extensors Muscles Strength (MS), the seated Modified Functional Reach (MFR) test, and Heart Rate Variability (HRV) measures. Logistic and Cox regression were used. RESULTS: Twenty-four participants (66.7%) completed the sub-acute rehabilitation phase being independent in ascending and descending stairs. MFR was the best predictor (R2 = 0.18), and with MS the best predictors for the time (days) to achieve this goal during the sub-acute rehabilitation. HRV measure was found to be the main predictor of the staircase ascent model (R2 = 0.32), and MFR the best predictor for the descent model (R2 = 0.24). CONCLUSIONS: Balance performance is the main predictor of independence in ascending and descending stairs. Improving this component during the sub-acute rehabilitation phase might be reflected in achieving staircase independence.

[RECRUITMENT PATTERNS OF HOMOLOGOUS MUSCLES DURING UNILATERAL MOVEMENT IN HEMIPARETIC SUBJECTS].

INTRODUCTION: The presence of unintentional muscular activity, with or without overt movement, in the homologue muscle contralateral to the limb being activated voluntarily, has been documented in both healthy and hemi-paretic populations. This activity has been termed contra-lateral motor irradiation (CMI), mirror movement, associated movement, motor overflow or synkinesis. AIMS: To characterize the CMI phenomenon amongst healthy controls and patients with varying degrees of motor ability and also to assess the ability to consciously control this phenomenon. METHODS: A cross-sectional design was used to study sub-acute (within 6 weeks of the insult) stroke patients; assessments were performed within two weeks of commencing rehabilitation and again after 4 weeks. Healthy controls were assessed once. A simple motor task, unilateral extension of wrist and fingers, was examined. Concomitant muscular activity of the homologue muscle on the contralateral upper limb was the focus of interest; EMG activation was monitored on both sides. The Fugl-Meyer test was used to assess the residual motor capacity of the upper limb. RESULTS: CMI was demonstrated only in the non-paretic hand during voluntary activation of the paretic hand. The study group, unlike the control group, was unable to consciously reduce CMI. CONCLUSIONS: Although the mechanisms underlying CMI are poorly understood, they reflect an important aspect of inter-hemispheric relationship in motor control. In stroke patients, CMI monitoring by surface EMG can be used to assess its characteristics following damage to different elements of the motor system.

Atypical Within-Session Motor Procedural Learning after Traumatic Brain Injury but Well-Preserved Between-Session Procedural Memory Consolidation.

Using the finger-to-thumb opposition sequence (FOS) learning task, we characterized motor skill learning in sub-acute patients hospitalized for rehabilitation following traumatic brain injury (TBI). Ten patients (Trained TBI) and 11 healthy participants (Trained Healthy) were trained using a multi-session protocol: a single session was afforded in the first week of the study, and four daily sessions were afforded during the second week. Intensity of practice was adapted to patients. Performance speed and accuracy were tested before and after each session. Retention was tested 1 month later. Ten patients (Control TBI) had no FOS training and were tested only at the beginning and the end of the 6 week period. Although baseline performance on the FOS was very slow, all three phases of skill learning found in healthy adults (acquisition, between-session consolidation gains, and long-term retention) could be identified in patients with TBI. However, their time-course of learning was atypical. The Trained TBI group improved in speed about double the spontaneous improvements observed in the Control TBI group, with no speed-accuracy tradeoff. Normalized to their initial performance on the FOS, the gains accrued by the Trained TBI group after a first training were comparable to those accrued by healthy adults. Only during the second week with daily training, the rate of improvement of the Trained TBI group lagged behind that of the Trained Healthy group, due to increasing within-sessions losses in performance speed; no such losses were found in healthy participants. The Functional Independence Measure scores at the start of the study correlated with the total gains attained at the end of the study; no correlations were found with severity of injury or explicit memory impairments. Despite within-sessions losses in performance, which we propose reflect cognitive fatigue, training resulted in robust overall learning and long-term retention in patients with moderate-severe TBI. Given that the gains in performance evolved mainly between sessions, as delayed, offline, gains, our results suggest that memory consolidation processes can be effectively engaged in patients with TBI. However, practice protocols and schedules may need to be optimized to better engage the potential for long-term plasticity in these patients.

Specialized stroke rehabilitation services in seven countries: Preliminary results from nine rehabilitation centers.

BACKGROUND: There is a lack of defined levels of rehabilitation, indicating possibly random content and access to specialized services. AIMS AND/OR HYPOTHESIS: The aim of the study was to perform a multinational descriptive study of specialized rehabilitation in persons with stroke, to elucidate what the different centers define as prerequisites for specialized rehabilitation, and to analyze whether these descriptions map to currently applied standards or constructs of specialized rehabilitation. A secondary aim was to look for similarities and differences between therapies and services for persons with stroke in the sub-acute stage in the different institutions. METHODS: Descriptive data of the collaborating centers regarding structure and processes of services were recorded and compared with the British Society of Rehabilitation Medicine and Specialized Services National Definitions sets. RESULTS: Comparisons of the definitions showed that all centers admitted severely disabled persons with stroke, in need of complex rehabilitation, and provided high levels of physical services, with specialized equipment and facilities. However, funding, size, university affiliation, quality accreditation, staffing levels, specialist training, cognitive and vocational services, coordination of the professional teams, admission procedures, time and type of therapies, estimated length of stay, and follow-up procedures differed between the centers. CONCLUSION: This multinational study of specialized stroke rehabilitation centers shows that a universal definition of specialized rehabilitation is possible, even in quite different countries and settings, in terms of general principles. There were however differences in structures and procedures, which may influence patients' outcomes, indicating a need for refinement of the definitions to be globally applicable.

Monitoring changes in heart rate, as an indicator of the cardiovascular autonomic nervous function, among patients at the sub-acute phase post-brain damage during a physiotherapy session: a preliminary investigation.

OBJECTIVES: To assess cardiovascular autonomic nervous system function of patients post-brain-injury in the sub-acute phase during a physiotherapy session (PTS). PARTICIPANTS: Fourteen patients post-ischaemic stroke and 11 post-severe traumatic brain injuries. INTERVENTION: Continuous electrocardiogram recording at rest, during active cycling and during routine PTS. MAIN OUTCOME MEASURE: Heart rate (HR) and Heart rate variability (HRV) parameters included the standard deviation of all R-R intervals (SDNN), the square root of the mean squared differences of successive differences (RMSSD), the Low-frequency (LF) power, High-frequency (HF) power and the LF/HF ratio. RESULTS: The median HR at rest was 76 bpm (interquartile range 61-81). Significant increments were noted during activities; median HR during cycling was 93 bpm, during the most intense activity 91 bpm (p-value < 0.001). A significant decline in HRV parameters' median values during cycling and PTS was observed only among patients post-stroke. CONCLUSIONS: Among patients post-brain injury, HR increased significantly during PTS in different activities and varied positions; therefore, therapists should be aware and monitor HR frequently during training. In addition, HRV values were low at rest and did not respond to activity among patients post-TBI, compared with higher values at rest and some response among patients post-stroke. This may indicate that autonomic impairment post-brain insult is more likely a consequence of central nervous system damage and less likely a result of pre-event cardiovascular illness.

Extracorporeal Shock Wave Therapy (ESWT) as a treatment for recurrent Neurogenic Heterotopic Ossification (NHO).

PRIMARY OBJECTIVE: To describe the effects of extracorporeal shock wave therapy (ESWT) on neurogenic heterotopic ossification (NHO). RESEARCH DESIGN: A single case study was considered the most appropriate methodology in this situation. METHODS AND PROCEDURES: The subject was a 43 year old female 10 years post-traumatic brain injury with recurring NHO around the hip joint. Baseline assessments of pain using a 10-point VAS, range of motion of the hip using a goniometer and walking ability (number of steps over a standard distance) were conducted. Four applications of ESWT using a Minispec™ Extracorporeal Shock Wave Lithotripsy machine (Medispec Int. USA) administered over 6 weeks to the anterolateral aspect of the right hip. Follow-up assessments were conducted weekly over the period of intervention and then monthly for 5 months. MAIN OUTCOMES AND RESULTS: Immediately following treatment, pain was reduced to 0 on the VAS scale; hip range of motion increased and the number of steps over a standard distance reduced, indicating increased step length. At 5-month follow-up, without further ESWT intervention, these results were maintained. CONCLUSION: This case study suggests that ESWT may be a non-invasive, low risk intervention for the management of NHO.

The effect of variable gait modes on walking parameters among children post severe traumatic brain injury and typically developed controls.

UNLABELLED: The goal of the present study was to assess the effect of various walking modes on dynamic gait characteristics and to evaluate the possible differences in the adaptation reactions between children post severe traumatic brain injury (TBI) and typically developed (TD) controls. METHODS: Thirteen children post severe TBI, mean of 3.5 years post trauma, independent walkers, with a walking velocity > 1.1 m/sec, and 15 TD controls participated in this study. Ages were 7-13 years. Gait speed, step time and length and step time and length variability were assessed by an electronic walkway. The children completed three cycles on the walkway for each of the following situations: comfortable walking, walking as fast as possible, as slow as possible and walking on a straight line. RESULTS: Despite a similar walking performance while walking at a "regular" speed, children post severe TBI exhibit a significantly reduced range of walking speeds (73-154 cm/sec), about half, as compared to TD children (54-193 cm/sec) across the study assignments. In addition, while "walking on a straight line" children post TBI walk slower, with increased step variability as compared to their peers. CONCLUSION: Children post severe traumatic brain injury may achieve independent walking at a comparable rate to typically developed controls; however their impairments will be exacerbated as the demands increase. Since a variety of walking speeds is crucial for independent daily living at any age and for children in particular, and since adequate balance is an inherent element of walking, these issues need repeated assessments and the children should receive appropriate treatment.

Effect of concurrent cognitive tasks on gait features among children post-severe traumatic brain injury and typically-developed controls.

AIM: To investigate and compare the influence of concurrent cognitive tasks on gait characteristics in children post-traumatic brain injury (TBI) and typically-developed (TD) controls. METHODS: Fifteen children post-TBI (aged 9.5 ± 2.2 years) and 15 TD controls (aged 9.9 ± 1.3 years) were included in the study. The children were asked to walk under three conditions: (1) walking at a self-selected speed, (2) walking at a self-selected speed while memorizing and recalling a series of three random numbers and (3) walking at a self-selected speed while listening and identifying commonly experienced sounds. Gait parameters include walking speed, step time and length and step time and length variability as measured with the GAITRite(®) system. RESULTS: Introduction of a concurrent task led to decreased walking speed and step length and increased step time and step length variability in both groups, but with a significantly prominent effect in children post-TBI. The results also showed that the effect of a concurrent cognitive task on walking depended on the complexity level of the task. CONCLUSION: When children were asked to perform an additional task while they were walking, this had a negative effect on their gait. One may deduce from these results that control of the rhythmic stepping mechanism at a self-selected walking speed in children is dependant to an extent on their ability to focus attention on their gait. In children post-TBI who usually have an attention deficit anyway, this ability is severely disturbed.

Recreational physical activities among children with a history of severe traumatic brain injury.

OBJECTIVE: To describe leisure time physical activity (LTPA) and physical capabilities such as balance, muscle strength and walking performance and to evaluate the associations between physical capabilities and LTPA among children post-traumatic brain injury (TBI) as compared to a peer group of typically-developed (TD) controls. PARTICIPANTS: Convenience sample of 15 children, 1.5-7 years post-severe TBI and 15 age- and sex-matched controls. MAIN OUTCOME MEASURES: LTPA by the Godin and Shephard (G&S) questionnaire. Balance tests-the Timed Up and Go test (TUG) and functional reach test (FRT). Maximal isometric strength was assessed by using a hand-held dynamometer; walking dynamics were recorded by an electronic mat and the 6 minute walk test and energy expenditure index (EEI). Perceived exertion was rated by the OMNI scale. RESULTS: Children post-severe TBI participate significantly less in LTPA as compared to TD controls (p < 0.01). Walking performance was comparable between groups except for step length which was significantly shorter among children post-TBI. Hip extensor strength and balance performance were significantly lower among children post-TBI. Balance performance was positively associated with LTPA. CONCLUSIONS: This study suggests that attention should be directed towards improving balance performance as part of the training repertoire of children and adolescents with post-severe TBI. The efficacy of such a training programme, in particular its contribution to LTPA participation, should then be further assessed.

The immediate effect of treadmill walking on step variability in boys with a history of severe traumatic brain injury and typically-developed controls.

OBJECTIVE: To examine the immediate effect of treadmill walking (i.e. enforced walking at a fixed gait velocity) on gait variability among children post-severe traumatic brain injury (TBI) and typically-developing (TD) age-matched controls. METHODS: Twelve boys post-severe TBI and 18 TD boys participated in this study. Ages were 7-13 years. Step time and length variability were assessed by an electronic walkway prior to and after treadmill walking for 6 minutes. RESULTS: Significantly reduced walking velocity and step length, with significantly increased step length variability were noted among children post-TBI compared to the TD subjects when walking on level ground prior to the treadmill. Treadmill walking reduced step length variability in TD children, while there was a slight increase in variability in children post-TBI (p < 0.05). CONCLUSION: Walking on a treadmill at a fixed gait velocity has a different effect on boys post-severe TBI and TD controls.

The specificity of memory for a highly trained finger movement sequence: Change the ending, change all.

How are highly trained movement sequences represented in long-term memory? Here we show that the gains attained in the performance of a well-trained sequence of finger movements can be expressed only when the order of the movements is exactly as practiced. Ten young adults were trained to perform a given 5-element sequence of finger-to-thumb opposition movements with their left hand. Movements were analyzed using video based tracking. Three weeks of training resulted, along with improved accuracy, in robustly shortened movement times as well as shorter finger-to-thumb touch times. However, there was little transfer of these gains in speed to the execution of the same component movements arranged in a new order. Moreover, even when the only change was the omission of the one before final movement of the trained sequence (Omit sequence), the initial movements of the sequence were significantly slowed down, although these movements were identical to the initial movements of the trained sequence. Our results support the notion that a well-trained sequence of finger movements can be represented, in the adult motor system, as a singular, co-articulated, unit of movement, in which even the initial component movements are contingent on the subsequent, anticipated, ones. Because of co-articulation related anticipatory effects, gains in fluency and accuracy acquired in training on a specific movement sequence cannot be expressed in full in the execution of the trained component movements or of a full segment of the trained sequence, if followed by a different ending segment.

Heart rate and heart rate variability at rest and during exercise in boys who suffered a severe traumatic brain injury and typically-developed controls.

OBJECTIVES: To measure heart rate (HR) and heart rate variability (HRV) at rest and during exercise in children with post-severe traumatic brain injury as compared to age-matched typically-developed controls. DESIGN: Comparative study. SETTING: Out-patient rehabilitation department. PARTICIPANTS: Twelve boys post-severe traumatic brain injury (TBI) (aged 7-13 years) and 18 typically-developed (TD) boys matched for age. INTERVENTIONS: HR and HRV were determined at rest and at a steady functional walking rate on the treadmill. MAIN OUTCOME MEASURES: HR and HRV parameters include: time domain parameters: standard deviation of the R-R interval, square root of the mean squared differences of successive R-R differences at rest and during steady-state exercise. RESULTS: Children post-TBI demonstrated higher mean HR values at rest (TBI 91.8 +/- 7.0 beats per minute vs 72.0 +/- 7.1 beats per minute in controls, p < 0.05) and during exercise (TBI 123.4 +/- 15.5 beats per minute vs 113.0 +/- 9.1 beats per minute in controls, p < 0.05). At rest, the time domain measures of HRV were significantly lower in the TBI group (p < 0.05). Time domain mean values decreased significantly during exercise only among the TD children. CONCLUSIONS: The findings of this study suggest that among children post-severe TBI, the cardiac autonomic mechanism is less efficient at rest and less adaptive to exercise and activity as compared to TD children.

The effects of a 'home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury.

OBJECTIVES: To evaluate the feasibility and the ability to recruit and retain children with severe traumatic brain injury or cerebral palsy, and their families, to a simple home-based exercise programme and to assess the immediate and short-term effects of such intervention on reducing impairment and improving function. STUDY DESIGN: Randomized clinical trial. PARTICIPANTS: Twenty children aged 7-13 years, with traumatic brain injury (N = 10) or cerebral palsy (N = 10) who were independent ambulators. Five children from each group were randomly assigned to a control group - regular daily activities, or to an experimental group - regular daily activities plus a home-based task-oriented exercise programme of sit-to-stand and step-up exercise, for six weeks. OUTCOME MEASURES: Feasibility: The number of participants who completed the programme protocol. EFFICACY: Timed Up and Go Test and Functional Reach Test were used as functional balance tests. Maximal isometric strength was assessed by using a hand-held dynamometer; walking performance was assessed by the 10 m walk test, 2-minute walk test and Energy Expenditure Index. RESULTS: Nine children completed all parts of the training programme. At the end of the intervention period an increase of 3-4 cm in the mean Functional Reach Test and a reduction of 1.6 +/- 2.1 seconds in the Timed Up and Go Test were noted (P<0.01) in the experimental group while no changes were noted in the control group. In all other outcomes assessed no significant differences were noted between groups. The positive change in balance performance in the experimental group was maintained during a six-week follow-up period. CONCLUSIONS: A home-based task-oriented exercise programme can improve balance performance in children with spastic cerebral palsy or severe traumatic brain injury.

Balance abilities and gait characteristics in post-traumatic brain injury, cerebral palsy and typically developed children.

OBJECTIVES: To quantify the differences in gait variability and balance performance between children with cerebral palsy (CP), children with post-traumatic brain injury (TBI) and typically developed (TD) children and to determine the association between gait variability and functional balance in these groups. DESIGN: Cross-sectional study. SETTING: Physical therapy department of a paediatric and adolescent rehabilitation hospital. PARTICIPANTS: A convenience sample of 15 children post-TBI, 15 children with CP and 30 TD age- and sex-matched controls. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Step length and step time variability measured by an electronic walkway; timed up and go (TUG) test and functional reach test (FRT) were used as functional balance tests. RESULTS: The functional balance abilities of children post-TBI and children with CP were significantly limited compared to TD children. Children post-TBI had significantly greater variability in step length in comparison to healthy controls. A significant linear inverse correlation between balance performance and step length variability was found only among children with TBI. CONCLUSION: Brain damage is associated with restricted balance performance and increased step variability. It might be that in a child born with brain damage, as opposed to acquired damage, the developmental process has a restraining effect on gait variability.

The relationship between step variability, muscle strength and functional walking performance in children with post-traumatic brain injury.

The objective of this study was to investigate the association between step variability, muscle strength and functional walking performance in children post-traumatic brain injury (TBI) and typically developed (TD) children. A convenience sample of 16 children post-TBI and 16 TD age and sex matched controls participated in this cross sectional study. The main outcome measures included step length and step time variability, measured with an electronic walkway, strength of four lower-extremity muscle groups, tested bilaterally with a hand held dynamometer, walking performance as assessed by the 2-min walk test, energy expenditure index (EEI) and rating of perceived exertion (OMNI scale). Significant differences were found in walking parameters between the groups (e.g., 2-min walk test: TBI 109+/-31 compared to TD 168+/-19 m). Children post-TBI had significantly greater variability in step time and step length in comparison to TD controls (e.g., step length variability: TBI 16.3+/-13.6 compared to TD 4.9+/-2.0). TD children had significantly higher mean strength values than children post-TBI in the knee extensor and hip abductor muscle groups (p<0.05). The 2-min walk test correlated inversely with the step time and length variability only among children post-TBI while muscle strength values correlated positively with the 2-min walk test only in TD children. This study found that step time and length variability and lower-extremity muscle strength correlated differently to distance covered during the 2-min walk test among children post-TBI and among TD children.

Functional balance tests for children with traumatic brain injury: within-session reliability.

PURPOSE: To assess the within-session reliability of the Modified Functional Reach Test (MFRT) and the Timed Up and Go (TUG) test in children with traumatic brain injury (TBI) and children with typical development (TD). METHODS: A convenience sample of 24 children with TBI and 24 children with TD matched for age and sex were tested. Following 1 practice trial, 3 trials of the MFRT and TUG were completed and recorded for each child. RESULTS: Within-session reliability for the MFRT was excellent [children with TBI (intraclass correlation coefficient, ICC (1,1) = 0.92-0.97), children with TD (ICC (1,1) = 0.94-0.95)]. Within-session reliability for the TUG test was good [children with TBI (ICC (1,1) = 0.86), children with TD (ICC (1,1) = 0.85)]. The average of the first and second trials showed the least measurement error for the TUG test. CONCLUSION: Within-session reliability values are excellent for the MFRT and good for the TUG test in children with TBI.

Relationship between balance abilities and gait characteristics in children with post-traumatic brain injury.

OBJECTIVES: To quantify the differences in gait variability and balance performance between typically developed (TD) children and children with post-traumatic brain injury (TBI) and to determine the association between gait variability and functional balance in both groups. DESIGN: Cross-sectional study. SETTING: Physical therapy department of a paediatric and adolescent rehabilitation hospital. PARTICIPANTS: A convenience sample of 24 children post-TBI and 24 TD age and sex matched controls. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Step length, step time and base width variability measured with an electronic walkway; timed up and go (TUG) test and functional reach test (FRT) as a functional balance test. RESULTS: Base width and step time variability showed no significant difference between the groups. However, children post-TBI had significantly greater variability in step length in comparison to healthy controls. The functional balance abilities of children post-TBI were significantly limited compared to TD children. A significant linear inverse correlation was found between balance performance and step length variability only among children with a TBI. CONCLUSION: Ambulatory children post-severe TBI had decreased balance performance, decreased gait speed and increased step length variability as compared to age-matched healthy controls.

Use of medical technologies in rehabilitation medicine settings in Israel: results of the TECHNO-R 2005 survey.

BACKGROUND: With the development of computer technology and the high-tech electronic industry over the past 30 years, the technological age is flourishing. New technologies are continually being introduced, and questions regarding the economic viability of these technologies need to be addressed. OBJECTIVES: To identify the medical technologies currently in use in different rehabilitation medicine settings in Israel. METHODS: The TECHNO-R 2005 survey was conducted in two phases. Beginning in 2004, the first survey used a questionnaire with open questions relating to the different technologies in clinical use, including questions on their purpose, who operates the device (technician, physiotherapist, occupational therapist, physician, etc.), and a description of the treated patients. This questionnaire was sent to 31 rehabilitation medicine facilities in Israel. Due to difficulties in comprehension of the term "technology," a second revised standardized questionnaire with closed-ended questions specifying diverse technologies was introduced in 2005. The responder had to mark from a list of 15 different medical technologies which were in use in his or her facility, as well as their purpose, who operates the device, and a description of the treated patients. RESULTS: Transcutaneous electrical nerve stimulation, the TILT bed, continuous passive movement, and therapeutic ultrasound were the most widely used technologies in rehabilitation medicine facilities. Monitoring of the sitting position in the wheelchair, at the bottom of the list, was found to be the least used technology (with 15.4% occurrence). Most of the technologies are used primarily for treatment purposes and to a lesser degree for diagnosis and research. CONCLUSIONS: Our study poses a fundamental semantic and conceptual question regarding what kind of technologies are or should be part of the standard equipment of any accredited rehabilitation medicine facility for assessment, treatment and/or research. For this purpose, additional data are needed.