Anatomical parameters alter the biomechanical responses of adjacent segments following lumbar fusion surgery: Personalized poroelastic finite element modelling investigations.

Introduction: While the short-term post-operative outcome of lumbar fusion is satisfying for most patients, adjacent segment disease (ASD) can be prevalent in long-term clinical observations. It might be valuable to investigate if inherent geometrical differences among patients can significantly alter the biomechanics of adjacent levels post-surgery. This study aimed to utilize a validated geometrically personalized poroelastic finite element (FE) modeling technique to evaluate the alteration of biomechanical response in adjacent segments post-fusion. Methods: Thirty patients were categorized for evaluation in this study into two distinct groups [i.e., 1) non-ASD and 2) ASD patients] based on other long-term clinical follow-up investigations. To evaluate the time-dependent responses of the models subjected to cyclic loading, a daily cyclic loading scenario was applied to the FE models. Different rotational movements in different planes were superimposed using a 10 Nm moment after daily loading to compare the rotational motions with those at the beginning of cyclic loading. The biomechanical responses of the lumbosacral FE spine models in both groups were analyzed and compared before and after daily loading. Results: The achieved comparative errors between the FE results and clinical images were on average below 20% and 25% for pre-op and post-op models, respectively, which confirms the applicability of this predictive algorithm for rough pre-planning estimations. The results showed that the disc height loss and fluid loss were increased for the adjacent discs in post-op models after 16 h of cyclic loading. In addition, significant differences in disc height loss and fluid loss were observed between the patients who were in the non-ASD and ASD groups. Similarly, the increased stress and fiber strain in the annulus fibrosus (AF) was higher in the adjacent level of post-op models. However, the calculated stress and fiber strain values were significantly higher for patients with ASD. Discussion: Evaluating the biomechanical response of pre-op and post-op modeling in the non-ASD and ASD groups showed that the inherent geometric differences among patients cause significant variations in the estimated mechanical response. In conclusion, the results of the current study highlighted the effect of geometrical parameters (which may refer to the anatomical conditions or the induced modifications regarding surgical techniques) on time-dependent responses of lumbar spine biomechanics.

Sufficiency of the BOT-2 short form to screen motor competency in preschool children with strabismus.

BACKGROUND: Strabismus is one of the most common visual disorders in children, with a reported prevalence of 2.48% in preschoolers. Additionally, up to 89.9% of preschool children with strabismus do not have normal stereopsis. Whether this lack of normal stereopsis affects the motor competency of preschool children with strabismus is unknown. The Bruininks-Oseretsky Test of Motor Proficiency Second Edition short form (BOT-2 SF) can be a useful tool for screening; however, its sufficiency as a diagnostic tool for children with various disorders is controversial. OBJECTIVE: The aims of this study were thus to examine motor competency in preschool children with strabismus by using the BOT-2 and to evaluate the usefulness of the BOT-2 SF to identify those at risk for motor competency issues. METHODS: Forty preschool children (aged 5-7 years) with strabismus were recruited, all of whom had abnormal stereopsis. The BOT-2 complete form (CF) was administered to all children. The BOT-2 CF was administered to all children. The scores of the BOT-2 SF were extracted from the relevant items of the BOT-2 CF for further analysis. RESULTS: The prevalence of children with strabismus who had below average performance in the composites of "Fine Manual Control", "Manual Coordination","Body Coordination", and "Strength and Agility" were 15%, 70%, 32.5%, and 5%, respectively, on the BOT-2 CF. Compared with these results, the sensitivity of the BOT-2 SF was 33.33% (95% CI = 7.49%-70.07%) and the specificity was 100% (95% CI = 88.78%-100%). CONCLUSION: Preschool children with strabismus had a high prevalence of impaired motor competency, especially in fine motor competency. The BOT-2 SF was not as sensitive in identifying motor difficulties in preschool children with strabismus. Therefore, the BOT-2 CF is recommended for evaluating motor proficiency in preschool children with strabismus.

Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis.

Achieving a sufficient level of functional ambulation remains to be a challenge to most stroke survivors. Different modes of transcranial direct current stimulation (tDCS) have been applied for improving various aspects of walking and mobility following stroke. However, systematic reviews before 2017 provided only general effects of tDCS on limited walking outcomes. Therefore, the aims of this study were to update the evidence of tDCS for improving walking and mobility after stroke with emphasis on individual outcomes and to delineate the effects of different modes of tDCS in subgroup analysis. The systematic search of PubMed, Medline, PEDro, Scopus, and Cochrane databases for studies published up to January 2019 identified 14 eligible reports. The PEDro scale indicated a good methodological quality of the included studies (score 6.8). The meta-analysis of primary outcomes revealed that active tDCS had no better effect than sham on walking speed [n = 7, standardized mean difference (SMD) = 0.189, P = 0.252] and 6-minute walking distance (n = 3, SMD = 0.209, P = 0.453). Among the secondary outcomes, significant positive effects were found on functional ambulation category (FAC) (n = 5, SMD = 0.542, P = 0.008), Rivermead Mobility Index (n = 3, SMD = 0.699, P = 0.008), and timed up and go test (TUG) (n = 5, SMD = 0.676, P = 0.001), whereas non-significant positive effects were found on Tinetti test (n = 3, SMD = 0.441, P = 0.062) and Berg Balance Scale (n = 2, SMD = 0.408, P = 0.177). In subgroup analyses, anodal tDCS had significant positive effects on FAC (n = 4, SMD = 0.611, P = 0.005) and dual-hemispheric tDCS on TUG (n = 2, SMD = 1.090, P = 0.000). The results provide up-to-date evidence of variable effects of tDCS on walking and functional mobility after stroke.

Early and anticipatory postural adjustments in healthy subjects under stable and unstable sitting conditions.

Clinicians frequently incorporate unstable sitting devices into training plans for improving proximal postural muscle control; however, the effect of unstable sitting conditions on postural adjustments during dynamic activities has not been fully explored. The aim of this study was to characterize early postural adjustments (EPAs) and anticipatory postural adjustments (APAs) under stable and unstable sitting conditions. Using a cross-sectional laboratory study design, 13 healthy college student volunteers used their dominant hand to reach forward and push a target under stable and unstable sitting conditions; subjects sat on an air-filled rubber cushion for the unstable condition. EPAs and APAs were quantified by recording muscle activation of the trunk and lower extremity muscles using electromyography (EMG). The center of pressure (COP) was measured using a force plate. The resulting EMG integral of the ipsilateral gastrocnemius muscle was larger during the EPA phase and smaller during the APA phase under unstable conditions (p = 0.014 and p = 0.041, respectively). COP amplitude in the anterior-posterior direction, path length, and velocity, was larger during the APA phase (p = 0.035, p = 0.023, and 0.023, respectively). This suggests greater distal muscle activation during EPAs in unstable sitting conditions, specifically in the ipsilateral gastrocnemius muscle. In addition, APAs adjusted by reducing the activity of the ipsilateral gastrocnemius muscle and increasing the anterior-posterior shift in the COP to compensate for the expected additional perturbation due to an unstable surface.

A Pediatric Service-Learning Program in Physical Therapy Education.

PURPOSE: The purpose of this report was to describe a pediatric service-learning program in entry-level physical therapy (PT) education in Taiwan. KEY POINTS: To meet the needs of the local community and provide preclinical service-learning experience to PT students with people with physical disability, a service-learning program of a 2-day camp for children with cerebral palsy (CP) was developed in 2012. To date, 356 entry-level PT students have participated in this program, serving 286 children and their families. Important professional attributes, identified by the World Confederation for Physical Therapy guideline, such as altruism, compassion and caring, cultural competence, personal and professional development, professional duty, social responsibility and advocacy, and teamwork, were in the reflective reports of some of the PT students. CONCLUSIONS: The experiences provided by this pediatric PT service-learning program appear to have the potential to foster the development of professional attributes in entry-level PT students.

Effect of forced use of the lower extremity on gait performance and mobility of post-acute stroke patients.

[Purpose] The purpose of this study was to investigate the effects of a forced-use training program on gait, mobility and quality of life of post-acute stroke patients. [Subjects] Twenty-one individuals with unilateral stroke participated in this study. All participants had suffered from first-ever stroke with time since onset of at least 3 months. [Methods] A single-blinded, non-equivalent, pre-post controlled design with 1-month follow-up was adopted. Participants received either a forced-use or a conventional physical therapy program for 2 weeks. The main outcomes assessed were preferred and fastest walking velocities, spatial and temporal symmetry indexes of gait, the timed up and go test, the Rivermead Mobility Index, and the Stroke-Specific Quality of Life Scale (Taiwan version). [Results] Forced-use training induced greater improvements in gait and mobility than conventional physical therapy. In addition, compared to pre-training, patients in the conventional physical therapy group walked faster but more asymmetrically after training. However, neither program effectively improved in-hospital quality of life. [Conclusion] The forced-use approach can be successfully applied to the lower extremities of stroke patients to improve mobility, walking speeds and symmetry of gait.

Deficits in sensory organization for postural stability in children with Tourette syndrome.

Tourette syndrome (TS) is a childhood-onset developmental disorder characterized by involuntary motor and vocal tics. Previous studies have indicated that children with TS demonstrate postural control anomalies when standing. The aim of this study was to compare postural stability under normal and altered sensory conditions in children with TS and healthy control (HC) children. A convenience sample of twelve children with TS (9 boys and 3 girls; 9.4 ± 1.1 yr) and 12 HC age- and gender-matched children (9.2 ± 1.1 yr) participated in this study. The Sensory Organization Test (SOT) was used to assess postural stability under six altered sensory conditions (1. normal vision, fixed support; 2. eyes closed, fixed support; 3. vision sway-referenced, fixed support; 4. normal vision, support sway-referenced; 5. eyes closed, support surface sway-referenced; 6. both vision and support surface sway-referenced) using the SMART Balance Master® 8.2 (NeuroCom® International, Inc, Clackamas, OR, USA). The results showed significant differences between the two groups in conditions 5 and 6 (p=0.003 and 0.002, respectively). The mean composite equilibrium score in children with TS was significantly lower than that of HC children (p<0.000). The results suggested that children with TS had greater difficulty in maintaining postural stability, especially when vestibular information was challenged. The results of this study provide supporting evidence for possible deficits in impaired access to vestibular information and sensorimotor integration of postural control in children with TS.

Within-session acquisition of anticipatory postural adjustments during forward reaching task.

OBJECTIVE: To describe the acquisition of anticipatory postural adjustment (APA) in healthy adults during standing forward reaching. DESIGN: Repeated-measures design Subjects/Patients: Ten healthy subjects. METHODS: Within one day, all subjects practiced forward reaching to a moving target for sixty trials (10 trials, 6 blocks). APAs were recorded by electromyography (EMG), center of pressure (COP), and kinematic measurements. Repeated measure ANOVA was used to compare the changes of APA among the six blocks. RESULTS: All subjects showed basic APA patterns in the beginning, such as posterior shift of COP and tibialis anterior firing first. The adults demonstrated significantly quicker onset of posterior shift of COP between block 2 and 6 (p<0.05) and decreased muscle activation of ispilateral tibialis anterior between block 1 and 3 (p=0.01). CONCLUSIONS: The results suggested the acquisition process of APA could be observed after 50 trials of practice. Further study will need to verify the optimal practice trials in different populations with movement disorders.

Spatio-temporal gait characteristics in children with Tourette syndrome: a preliminary study.

Earlier studies had suggested that variability of stride length in gait is a pathological sign of basal ganglia disease. Some evidence implicates the involvement of the basal ganglia and related thalamocortical circuitry in Tourette syndrome (TS). To date, the gait of subjects with TS has only discussed in case reports. This investigation compared the spatial and temporal gait characteristics of a sample of children with TS (N=8) with those of healthy controls (HC; N=8). All children were instructed to walk under two speed conditions: "preferred" and "fastest." Gait parameters were measured using an electronic walkway. Spatial and temporal gait parameters were compared using a two-way (group)×(conditions) repeated measures ANOVA. The preliminary results suggested that similar to HC children, children with TS were capable of regulating temporal characteristics of gait based on walking speed. They also exhibited subtle gait anomalies such as irregular step length, as evidenced by significant differences in step length differential (p=0.003), detectable despite the small sample size. These findings warrant further investigation into the gait control of children with TS.

Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation.

OBJECTIVE: To investigate the predictors of minimal clinically important changes on outcome measures after robot-assisted therapy (RT). DESIGN: Observational cohort study. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: A cohort of outpatients with stroke (N=55). INTERVENTIONS: Patients with stroke received RT for 90 to 105min/d, 5d/wk, for 4 weeks. MAIN OUTCOME MEASURES: Outcome measures, including the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), were measured before and after the intervention. Potential predictors include age, sex, side of lesion, time since stroke onset, finger extension, Box and Block Test (BBT) score, and FMA distal score. RESULTS: Statistical analysis showed that the BBT score (odds ratio[OR]=1.06; P=.04) was a significant predictor of clinically important changes in the FMA. Being a woman (OR=3.9; P=.05) and BBT score (OR=1.07; P=.02) were the 2 significant predictors of clinically significant changes in the MAL amount of use subscale. The BBT score was the significant predictor of an increased probability of achieving clinically important changes in the MAL quality of movement subscale (OR=1.07; P=.02). The R(2) values for the 3 logistic regression models were low (.114-.272). CONCLUSIONS: The results revealed that patients with stroke who had greater manual dexterity measured by the BBT appear to have a higher probability of achieving clinically significant motor and functional outcomes after RT. Further studies are needed to evaluate other potential predictors to improve the models and validate the findings.

Hypoxic exercise training improves cardiac/muscular hemodynamics and is associated with modulated circulating progenitor cells in sedentary men.

BACKGROUND: Circulating progenitor cells (CPCs) improve cardiovascular function and organ perfusion by enhancing the capacities of endothelial repair and neovasculogenesis. This study investigates whether exercise regimens with/without hypoxia affect cardiac and muscular hemodynamics by modulating CPCs and angiogenic factors. METHODS: Forty sedentary males were randomly divided into hypoxic (HT, n=20) and normoxic (NT, n=20) training groups. The subjects were trained on a bicycle ergometer at 60%VO(2max) under 15% (HT) or 21% (NT) O2 conditions for 30 min daily, five days weekly for five weeks. RESULTS: After the five-week interventions, the HT group exhibited a larger improvement in aerobic capacity than the NT group. Furthermore, the HT regimen (i) enhanced cardiac output (Q(H)) and perfusion (Q(M))/oxygenation of vastus lateralis during exercise; (ii) increased levels of CD34(+)/KDR(+)/CD117(+), CD34(+)/KDR(+)/CD133(+), and CD34(+)/KDR(+)/CD31(+) cells in blood; (iii) promoted the proliferative capacity of these CPC subsets, and (iv) elevated plasma nitrite/nitrate, stromal cell-derived factor-1 (SDF-1), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor-A (VEGF-A) concentrations. Despite the lack of changes in Q(H) and the number or proliferative capacity of CD34(+)/KDR(+)/CD117(+) or CD34(+)/KDR(+)/CD31(+) cells, the NT regimen elevated both Q(M) and plasma nitrite/nitrate levels and suppressed the shedding of endothelial cells (CD34(-)/KDR(+)/phosphatidylserine(+) cells). CONCLUSIONS: The HT regimen improves cardiac and muscular hemodynamic adaptations, possibly by promoting the mobilization/function of CPCs and the production of angiogenic factors.

Postural alignment in children with bilateral spastic cerebral palsy using a bimanual interface for powered wheelchair control.

OBJECTIVE: To examine postural alignment in children with bilateral spastic cerebral palsy while driving a powered wheelchair using both a unilateral joystick and an innovative bimanual interface. DESIGN: Cross-sectional study. SUBJECTS: A total of 20 children with bilateral spastic cerebral palsy (mean age 9.0 years (standard deviation 2.1); 11 with diplegia, 9 with quadriplegia) and 14 typically developing children (mean age 7.7 years (standard deviation 2.9)). METHODS: All children drove the powered wheelchair in both the unilateral and bimanual conditions. The Seated Postural Control Measure quantified the postural alignment of subjects while driving the powered wheelchair. Statistical analysis was carried out using repeated measures analysis of variance and Spearman's rank correlation coefficient. RESULTS: As expected, typically developing children had better postural alignment in both driving conditions than children with cerebral palsy. Children with cerebral palsy demonstrated more symmetrical postural alignment while using the bimanual interface than when using the unilateral joystick. In addition, the severity of cerebral palsy correlated moderately with postural symmetry in both conditions. CONCLUSION: The results suggest that this innovative bimanual interface might be beneficial for promoting symmetrical postural alignment in some children with bilateral spastic cerebral palsy.

Bimanual gliding control for indoor power wheelchair driving.

Power wheelchairs are essential for many individuals with mobility impairment. The objective of this study was to investigate the effectiveness of bimanual gliding (BG) and conventional joystick (CJ) control in an indoor environment, with application to (1) wheelchair driving performance (i.e., practice time, completion time, and driving deviation) and (2) muscle activity of the upper limbs. This study included 22 participants (11 experienced manual wheelchair users and 11 novice manual wheelchair users). Experienced wheelchair users who used the BG strategy needed less time to practice and complete the task. Muscle activity of the upper limbs was focused on the triceps brachii, with relatively less use of the wrist muscles while applying the BG strategy. In novice wheelchair users, wrist muscles were less involved when using the BG control compared with the CJ control. The findings imply that it is feasible to modify manual wheelchairs using BG and motors, which can serve as an alternative option for wheelchair users.

Scapular kinematics and muscle activities during pushing tasks.

OBJECTIVES: Pushing tasks are functional activities of daily living. However, shoulder complaints exist among workers exposed to regular pushing conditions. It is crucial to investigate the control of shoulder girdles during pushing tasks. The objective of the study was to demonstrate scapular muscle activities and motions on the dominant side during pushing tasks and the relationship between scapular kinematics and muscle activities in different pushing conditions. METHODS: Thirty healthy adults were recruited to push a four-wheel cart in six pushing conditions. The electromyographic signals of the upper trapezius (UT) and serratus anterior (SA) muscles were recorded. A video-based system was used for measuring the movement of the shoulder girdle and scapular kinematics. Differences in scapular kinematics and muscle activities due to the effects of handle heights and weights of the cart were analyzed using two-way ANOVA with repeated measures. The relationships between scapular kinematics and muscle activities were examined by Pearson's correlation coefficients. RESULTS: The changes in upper trapezius and serratus anterior muscle activities increased significantly with increased pushing weights in the one-step pushing phase. The UT/SA ratio on the dominant side decreases significantly with increased handle heights in the one-step pushing phase. The changes in upward rotation, lateral slide and elevation of the scapula decreased with increased pushing loads in the trunk-forward pushing phase. CONCLUSIONS: This study indicated that increased pushing loads result in decreased motions of upward rotation, lateral slide and elevation of the scapula; decreased handle heights result in relatively increased activities of the serratus anterior muscles during pushing tasks.

Effects of continuous passive motion on reversing the adapted spinal circuit in humans with chronic spinal cord injury.

OBJECTIVE: To investigate the possibility of restoring the adapted spinal circuit after spinal cord injury (SCI) by means of long-term continuous passive motion (CPM) of the ankle joint. DESIGN: Randomized controlled trial with repeated measures. SETTING: Research laboratory in a general hospital. PARTICIPANTS: Individuals with motor complete SCI (N=14) were recruited from a community. INTERVENTION: CPM of the ankle joint for 1 hour a day, 5 days a week for 4 weeks. MAIN OUTCOME MEASURES: Modified Ashworth Scale (MAS) scores for evaluation of spasticity and postactivation depression (PAD) were documented prior to and after intervention. RESULTS: MAS scores improved after 4 weeks of CPM intervention, indicating a reduction in spasticity of the ankle joint. PAD was restored after 4 weeks of training. CONCLUSIONS: Passive motion of the ankle joint alone was sufficient in reversing the adapted spinal circuit, and therefore indicates that spasticity after SCI could possibly be managed by CPM intervention. The results of this study support the use of the passive mode of robot-assisted therapy for humans with complete SCI who cannot exercise actively.

Effect of aerobic interval training on erythrocyte rheological and hemodynamic functions in heart failure patients with anemia.

BACKGROUND: Anemia disturbs hemorheological/hemodynamic properties, whereas aerobic interval training (AIT) achieves a superior aerobic fitness in patients with heart failure (HF). This study investigated whether AIT influences functional capacity by modulating hemorheological/hemodynamic functions in HF patients with/without anemia. METHODS: Sixty HF patients were divided into non-anemic (HF-NA, hemoglobin >/= 12 g/dL in women/ >/= 13 g/dL in men; n=30) and anemic (HF-A, hemoglobin<11 g/dL in women/<12 g/dL in men; n=30) groups, and 30 normal counterparts were enrolled as a control group. These HF patients performed AIT (3-minute intervals at 40% and 80%VO(2peak)) on a bicycle ergometer for 30 min/day, 3 days/week for 12 weeks. Erythrocyte rheological and central/peripheral hemodynamic characteristics were determined by slit-flow ektacytometer and bioreactance-based device/near infrared spectrometer, respectively. RESULTS: In both HF-NA and HF-A groups, the AIT regimen 1) reduced blood senescent/spherical erythrocyte counts, 2) diminished the values of critical shear stresses for disaggregation and half-maximal deformation of erythrocytes, 3) enhanced cardiac output during exercise, 4) heightened VO(2peak) and O2 uptake efficiency slope (OUES), and 5) decreased plasma myeloperoxidase and interleukin-6 levels. However, AIT increased the amounts of blood distributed to the frontal cerebral lobe and vastus lateralis muscle during exercise in HF-NA group but not in HF-A group. Additionally, HF-A group exhibited fewer the enhancements of VO(2peak) and OUES caused by AIT than HF-NA group did. CONCLUSION: AIT improves aerobic capacity and efficiency by depressing aggregability and enhancing deformability of erythrocytes in patients with HF. However, anemic comorbidity attenuates the adaptations of cerebral/muscular hemodynamic responses to exercise following this regimen.

Increases of quadriceps inter-muscular cross-correlation and coherence during exhausting stepping exercise.

The aim of this study was to examine the change of the intermuscular cross-correlation and coherence of the rectus femoris (RF), vastus medialis (VM) and vastus lateralis (VL) during exhausting stepping exercise. Eleven healthy adults repeated the stepping exercise up to their individual endurance limits (RPE score reached 20), and the cross-correlation and coherence were assessed by surface electromyography (EMG) recordings. The coefficient and time lag of cross-correlation and the coherence areas in the alpha (8-12 Hz), beta (15-30 Hz), gamma (30-60 Hz) and high-gamma (60-150 Hz) bands among the three muscle pairs (RF-VM, RF-VL and VM-VL) were calculated. As muscle fatigue, RF-VM and VM-VL showed increases of coefficients and the shortening of time lags. RF-VM and RF-VL showed increases of beta-band coherence in the ascent and descent phases, respectively. The increased intermuscular cross-correlation and beta-band coherence may be a compensatory strategy for maintaining the coordination of knee synergistic muscles during fatigue due to the fatigue-related disturbance of the corticospinal transmission. Therefore, the intermuscular cross-correlation and beta-band coherence may be a potential index for assessing muscle fatigue and monitoring the central control of motor function during dynamic fatiguing exercise.

Health-related physical fitness management for a child with Tourette syndrome.

Tourette syndrome (TS) is a neurobiological disorder characterized by tics, which are repetitive, stereotypical, involuntary movements and vocalizations. Although the causes of TS are not completely understood, previous studies indicated that many children with TS not only experience comorbid conditions such as a lack of concentration, hyperactivity, impulsive behavior, and obsessive-compulsive symptoms, but also demonstrate poorer motor skills than their peers with typical development. There is limited information on health-related fitness exercises and/or physical therapy for children with TS. A 12-year-old boy with TS demonstrated below-age appropriate motor function with a less optimal musculoskeletal condition, including pain in the posterior portion of both lower extremities. After performing individualized health-related physical fitness exercises, he demonstrated a better musculoskeletal condition and motor function. Unexpectedly, he reported he was able to suppress motor tics occasionally by doing stretching exercises. The results suggest that evaluation and management of health-related fitness may be helpful for children with TS. These promising results warrant further investigation of the impact of health-related physical exercises on children with TS.

Decrease of hypertonia after continuous passive motion treatment in individuals with spinal cord injury.

OBJECTIVE: To examine the effect of ankle continuous passive motion on the reflex excitability and overall hypertonia of calf muscles in individuals with chronic spinal cord injury and without physical disabilities. DESIGN: Two-way repeated measure experimental design. SETTING: Inpatient rehabilitation department in general hospital. SUBJECTS: The spinal cord injury group comprised eight individuals with chronic complete spinal cord injury and the control group comprised eight healthy people without physical disabilities. An additional eight healthy people were recruited as the sham group. INTERVENTIONS: Each subject received 60 min of continuous passive motion on the ankle joint. MAIN MEASURES: The H-reflex of the soleus muscle was elicited by tibia nerve stimulation just before, immediately after, and 10 min after continuous passive motion. The Modified Ashworth Scale (MAS) score at the ankle joint was recorded for the spinal cord injury group just before and 10 min after continuous passive motion therapy. RESULTS. After 60 min of continuous passive motion of the ankle joint, the H-reflex amplitude at the soleus muscle was depressed in individuals with and without spinal cord injury (77.46 +/- 32.64%, P = 0.047 and 51.76 +/- 26.74% of initial, P<0.0001, respectively). This depression persisted up to 10 min after continuous passive motion only in individuals without spinal cord injury. In individuals with spinal cord injury, the median of MAS scores decreased from 2 to 1.25 after continuous passive motion. CONCLUSION: Sixty minutes of continuous passive motion of the ankle joint decreased reflex excitability and overall hypertonia in people with or without spinal cord injury. The depression of overall hypertonia persisted longer than the reflex excitability in people with spinal cord injury.