The effects of different attentional focus on poststroke gait.

Attention may influence the motor performance of poststroke patients. The attentional focus implies "where" attention is focused while performing a specific movement. Focusing attention on the inside of the body while performing a specific exercise is called an internal focus (IF) and focus on the external environment is called an external focus (EF). This study examined the effect of attention on the gait of patients with chronic stroke. Sixteen subjects voluntarily participated in the study. The subjects were guided to walk while maintaining the required attentional focus, which is control, IF, and EF condition. Dependent variables were as follows: step length, stride length, step width, 10-m walk time, and weight distribution on the paretic limb. The results are as follows. First, the step length and the stride length were observed to be longer in the EF condition. Second, 10-m walk time was faster in EF condition. Third, under the EF condition, more weight was applied to the paretic limb. We suggest that EF instruction useful to improve the poststroke gait.

Reliability analysis of the Korean version of the trunk control measurement scale in cerebral palsy.

[Purpose] The purpose of this study was to translate the Trunk Control Measurement Scale into a Korean version and to analyze the intra- and inter-rater reliability. [Subjects and Methods] Fifteen children with spastic cerebral palsy and four physical therapists with over 10 years of clinical experience participated in this study. A Korean-American physical therapist translated the trunk control measurement scale from English into a Korean version. Four physical therapists viewed the video data of 15 children and scored each child's trunk control measurement scale performance on seven separate days. Four testers analyzed the test-retest reliability and inter-rater reliability using the intra-class correlation coefficient. [Results] Intra-class correlation coefficients for test-retest and inter-rater reliability for the Korean trunk control measurement scale showed significantly high reliability in all testers and sublevels. [Conclusion] The Korean version of the measurement scale is a reliable and suitable instrument for assessing trunk control in individuals with cerebral palsy in Korea.

Effects of seat surface inclination on respiration and speech production in children with spastic cerebral palsy.

BACKGROUND: Respiratory and speech problems are commonly observed in children with cerebral palsy (CP). The purpose of this study was to identify if inclination of seat surface could influence respiratory ability and speech production in children with spastic diplegic CP. METHODS: Sixteen children with spastic diplegic CP, ages 6 to 12 years old, participated in this study. The subjects' respiratory ability (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximum phonation time (MPT)) were measured in three sitting conditions: a seat surface inclined 0°, anterior 15°, and posterior 15°. RESULTS: FVC was significantly different across three inclinations of seat surface, F(2, 45) = 3.81, P = 0.03. In particular, the subjects' FVC at a seat surface inclined anterior 15° was significantly greater than at a seat surface inclined posterior 15° (P < 0.05). However, FEV1, PEF, and MPT were not significantly affected by seat surface inclination (P > 0.05). CONCLUSIONS: The results suggest that anterior inclination of seat surface may provide a positive effect on respiratory function in children with spastic diplegic CP.

Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients.

We investigated the effect of electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES; EMG-stim) on functional recovery of the hemiparetic hand and the related cortical activation pattern in chronic stroke patients. We enrolled 14 stroke patients, who were randomly assigned to the EMG-stim (n=7) or the control groups (n=7). The EMG-stim was applied to the wrist extensor of the EMG-stim group for two sessions (30 min/session) a day, five times per week for 10 weeks. Four functional tests (box and block, strength, the accuracy index, and the on/offset time of muscle contraction) and functional MRI (fMRI) were performed before and after treatment. fMRI was measured at 1.5 T in parallel with timed finger flexion-extension movements at a fixed rate. Following treatment, the EMG-stim group showed a significant improvement in all functional tests. The main cortical activation change with such functional improvement was shifted from the ipsilateral sensorimotor cortex (SMC) to the contralateral SMC. We demonstrated that 10-week EMG-stim can induce functional recovery and change of cortical activation pattern in the hemiparetic hand of chronic stroke patients.

Cortical activation changes induced by visual biofeedback tracking training in chronic stroke patients.

OBJECTIVES: We tried to examine whether visual biofeedback tracking training (VBTT) can improve both the gait performance and cortical activation pattern in chronic stroke patients. DESIGN: We enrolled 10 chronic hemiparetic patients with stroke(mean age 46.3 +/- 5.19 years). The patients were randomly assigned to the training group (5 patients) or the control group (5 patients). VBTT was to follow the PC-generated sine waves with the knee joint electrogoniometer, and the two sine waves should appear as close to overlapping as possible on the PC monitor. The training was performed for 39 minutes/day, 5 days/week, for 4 weeks. Pre-training and post-training accuracy of tracking, functional status of gait, and functional MRI (fMRI) were measured. fMRI was performed at 1.5 T in parallel with timed knee flexion-extension movements at a fixed rate. RESULTS: The accuracy of the tracking performance, walking speed, and motor scale for gait improved in the training group. Primary sensorimotor cortex (SM1) cortical activation shifted significantly from the unaffected to the affected hemisphere in the training group. CONCLUSIONS: We demonstrated that cortical activation changes occurred with gait function improvement in chronic stroke patients throughout the 4-week VBTT program. It seems that the cortical reorganization was induced by VBTT.

Poly(ADP-ribose) polymerase inhibition by cilostazol is implicated in the neuroprotective effect against focal cerebral ischemic infarct in rat.

This study shows that cilostazol displayed a potent inhibition of PARP with IC(50) of 883+/-41 nM in the enzyme assay, and also significantly reversed H(2)O(2)-evoked elevated PARP activity and reduced NAD(+) levels in the PC12 cells with improvement of cell viability. In in vivo study, inhibition of PARP activity by cilostazol prevented cerebral ischemic injury induced by 2-h middle cerebral artery occlusion (MCAO) and 24-h reperfusion. The ischemic infarct was significantly reduced in the rats that received cilostazol (30 mg/kg, twice orally) with improvement of neurological function. Moreover, cilostazol treatment significantly decreased the number of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)- and poly(ADP-ribose)-positive cells associated with apoptosis-inducing factor (AIF) translocation to the nucleus in the penumbral region. Further, cilostazol significantly reduced myeloperoxidase activity, a marker of neutrophil infiltration. In line with these findings, the OX-42- (a marker of microglia) and TNF-alpha-positive cells (a marker of proapoptotic protein) were markedly increased in the vehicle samples, both of which were significantly attenuated by treatment with cilostazol. Taken together, these results suggest that neuroprotective potentials of cilostazol against focal cerebral ischemic injury are, at least in part, ascribed to its anti-inflammatory effects and PARP inhibitory activity.

Quantitative EMG changes during 12-week DeLorme's axiom strength training.

Strength training is one of the most common exercises practiced in the field of physical therapy or sports training. However, limited methodology is available to evaluate its effect on the target muscle. This study aimed to test the hypothesis that surface electromyographic (EMG) data from both isometric and isotonic exercise can express changes within the muscle during a 12-week strength training program. Ten healthy male volunteer students (5 for training, 5 for controls) from Yonsei University were recruited for evaluation in this study. DeLorme's axiom was practiced for 12 weeks in the dominant elbow flexors and knee extensors of the training group. Tension for 1 repetition maximum and maximal voluntary isometric contraction, and surface EMG information such as the integrated EMG and three variables from the regression line of median frequency (MDF) data were measured at weeks 0, 3, 6, 9, and 12. The limb circumference was measured at weeks 0 and 12. During the strength training, which was enough for the increment of muscle strength and limb circumference, the rectified-integrated EMG and initial MDF increased with a significant linear pattern in both types of contraction. The two surface EMG variables were able to monitor the physiologic muscle changes during the training. Based on these results, we propose that these two surface EMG variables can be used for monitoring electrophysiological changes in the specific muscle that is undergoing the training program, under conditions where the contraction mode for EMG data collection is either static or dynamic.