Dynamic analysis of carbon emissions from construction and demolition activities in Japan: Revealed by high-resolution 4D-GIS modeling.

To meet the 2050 decarbonization target of the global buildings and construction sector, more attention is needed to reduce carbon emissions from construction and demolition. However, current national carbon accounting studies for these activities remain limited in spatial granularity and localized applicability. This study developed a bottom-up spatiotemporal database of carbon emissions from building construction and demolition in Japan via integrating a geographic information system-based building stock model, statistical data, and survey information. Focusing on municipal-level emissions, the Logarithmic Mean Divisia Index approach was used to decompose spatiotemporal variations and identify the contributing factors. Results indicate that carbon emissions from Japan's construction and demolition activities fell by more than 50% between 2005 and 2020, largely due to declining new/demolished-to-stock ratio, suggesting a transition to a stock-based society. Central cities' reliance on carbon-intensive buildings positively contributed to spatial variations in their construction emissions, underscoring the importance of sustainable materials and timber designs. Differences between prefectures in demolition emission intensity highlighted the strategic placement of recycling facilities in key regions to curb transportation-related emissions. Overall, these findings provided data reference for local governments to devise tailored policies for managing construction and demolition emissions.

Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: a randomized controlled trial.

BACKGROUND: Shoulder subluxation caused by paralysis after stroke is a serious issue affecting shoulder pain and functional prognosis. However, its preventive treatment has not been fully investigated. AIM: To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the prevention of shoulder subluxation. DESIGN: A single-center, parallel-group, prospective randomized, open-blinded, end-point study. SETTING: Convalescent rehabilitation ward. POPULATION: We included 50 inpatients in the convalescent rehabilitation ward with post-stroke, having upper limb paralysis, and the acromio-humeral interval (AHI) was within 1/2 finger-breadth. METHODS: A blinded computer-based allocation system was used to randomly assign patients into two groups: 1) conventional rehabilitation plus rPMS therapy (rPMS group, N=25); and 2) conventional rehabilitation alone (control group, N=25). Blinded assessors evaluated the patients before the intervention (T0), 6 weeks after (T1), and 12 weeks after (T2). The primary outcome was the change in AHIs from T0 to T1 between the groups. In contrast, the secondary outcomes were shoulder pain, spasticity, active range of motion, and Fugl-Meyer Assessment upper extremity (FMA-UE) score. RESULTS: Twenty-two patients in the rPMS group and 24 in the control group completed T1, whereas 16 in the rPMS group and 11 in the control group completed T2. The change in AHI was significantly lower in the rPMS group than in the control group ([95% CI, -5.15 to -0.390], P=0.023). Within-group analysis showed that AHI in the rPMS group did not change significantly, whereas it increased in the control group (P=0.004). There were no significant differences between T1 and T2 within or between the groups. Moreover, AHI did not show differences in patients with severe impairment but decreased in the rPMS group in patients with mild impairment (P=0.001). CONCLUSIONS: The rPMS may be a new modality for preventing shoulder subluxation. The association between motor impairment and the sustained effect needs to be further examined. CLINICAL REHABILITATION IMPACT: Applying rPMS to the muscles of the paralyzed shoulder after a stroke may prevent shoulder subluxation.

Effects of ankle-foot orthosis on gait pattern and spatiotemporal indices during treadmill walking in hemiparetic stroke.

Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.

Paving the way to the future: Mapping historical patterns and future trends of road material stock in Japan.

Roads are a fundamental component of societal infrastructure, whose decades-long lifespan has far-reaching implications for developmental decisions. The road construction and development have profound impacts on economic growth, social dynamics, and environmental sustainability. Therefore, comprehensive measurement of the current road material stock (MS) and the projection of expected future road scale based on regional socio-economic scenarios that can reflect unique local conditions are necessary. This study examined the historical changes and progression patterns of the road network across Japan from 1965 to 2020 through material flow and material stock analysis. By using the road MS time series, along with explanatory socioeconomic variables, several models including Autoregressive Integrated Moving Average with explanatory variables (ARIMAX), Support Vector Regression (SVR), hybrid ARIMAX-SVR, Multiple Linear Regression (MLR), Artificial Neural Networks (ANN), and Random Forest (RF) were compared. After comparison analysis, ARIMAX and hybrid ARIMAX-SVR models were employed to forecast expected road MS in each prefecture of Japan by 2050 based on national shared socioeconomic pathways (SSP) scenarios. The study found that the total road MS of Japan increased 5.5-fold over 55 years. Aggregate was the dominant material, comprising over 70 % among the four materials of the total road MS. The forecast results for each prefecture were classified into three different patterns. Expected MS in most prefectures still displayed increasing trends in the five scenarios, but the projection of road MS in eight prefectures revealed a notable downward trend across each SSP scenario. For most prefectures, SSP5 displayed the highest expected road MS, followed by SSP1. SSP3 was the scenario with the lowest MS. This approach provided a more thorough understanding of the likely evolution of road MS across different SSP scenarios and could help inform decisions for resource allocation and policy formulation concerning road infrastructure management.

Does Deep Learning Enhance the Estimation for Spatially Explicit Built Environment Stocks through Nighttime Light Data Set? Evidence from Japanese Metropolitans.

Built environment stocks have attracted much attention in recent decades because of their role in material and energy flows and environmental impacts. Spatially refined estimation of built environment stocks benefits city management, for example, in urban mining and resource circularity strategy making. Nighttime light (NTL) data sets are widely used and are regarded as high-resolution products in large-scale building stock research. However, some of their limitations, especially blooming/saturation effects, have hampered performance in estimating building stocks. In this study, we experimentally proposed and trained a convolution neural network (CNN)-based building stock estimation (CBuiSE) model and applied it to major Japanese metropolitan areas to estimate building stocks using NTL data. The results show that the CBuiSE model is capable of estimating building stocks at a relatively high resolution (approximately 830 m) and reflecting spatial distribution patterns, although the accuracy needs to be further improved to enhance the model performance. In addition, the CBuiSE model can effectively mitigate the overestimation of building stocks arising from the blooming effect of NTL. This study highlights the potential of NTL to provide a new research direction and serve as a cornerstone for future anthropogenic stock studies in the fields of sustainability and industrial ecology.

Development and preliminary evaluation of a tele-rehabilitation exercise system using computer-generated animation.

Objectives: To evaluate the safety and acceptability of a newly developed tele-rehabilitation exercise system using computer-generated animation. Methods: The participants comprised a convenience sample of 38 diverse individuals in Experiment 1 (15 healthy young people, 16 healthy older people, 5 patients with stroke, and 2 patients with respiratory disease) and 18 healthy older individuals in Experiment 2. Experiment 1 assessed safety in terms of cardiopulmonary vascular aspects and risk of fall, and Experiment 2 assessed treatment acceptability via a subjective evaluation. All participants completed the same exercise program. The safety assessment was conducted using heart rate (HR) and saturation of percutaneous oxygen (SpO2), measured before and after exercise. In addition, the occurrence of falls was assessed. For the acceptability assessment, the participants answered five questions (three-point Likert scale) after the exercise program. Results: The safety assessment indicated that HR and SpO2 changed from 70.5±10.2 beats per minute and 97.8±1.3% before exercise to 87.6±13.6 beats per minute and 98.2±0.9% after exercise, respectively. In addition, all participants completed the exercises without experiencing any falls. In the acceptability assessment, the score reflecting continuation desire was the highest of the five items examined (2.71±0.46). In contrast, the adequacy of exercise intensity had the lowest score (1.29±0.57). Conclusions: The present system was confirmed to be safe, and the participants were motivated to continue the exercises. Future developments should incorporate a function to enable participants and medical staff to adjust exercise intensity according to individual physical function.

Development of a simple mechanical measurement method to measure spasticity based on an analysis of a clinical maneuver and its concurrent validity with the modified Ashworth scale.

Background: Despite recent developments in the methodology for measuring spasticity, the discriminative capacity of clinically diagnosed spasticity has not been well established. This study aimed to develop a simple device for measuring velocity-dependent spasticity with improved discriminative capacity based on an analysis of clinical maneuver and to examine its reliability and validity. Methods: This study consisted of three experiments. First, to determine the appropriate motion of a mechanical device for the measurement of velocity-dependent spasticity, the movement pattern and the angular velocity used by clinicians to evaluate velocity-dependent spasticity were investigated. Analysis of the procedures performed by six physical therapists to evaluate spasticity were conducted using an electrogoniometer. Second, a device for measuring the resistance force against ankle dorsiflexion was developed based on the results of the first experiment. Additionally, preliminary testing of validity, as compared to that of the Modified Ashworth Scale (MAS), was conducted on 17 healthy participants and 10 patients who had stroke with spasticity. Third, the reliability of the measurement and the concurrent validity of mechanical measurement in the best ankle velocity setting were further tested in a larger sample comprising 24 healthy participants and 32 patients with stroke. Results: The average angular velocity used by physical therapists to assess spasticity was 268 ± 77°/s. A device that enabled the measurement of resistance force at velocities of 300°/s, 150°/s, 100°/s, and 5°/s was developed. In the measurement, an angular velocity of 300°/s was found to best distinguish patients with spasticity (MAS of 1+ and 2) from healthy individuals. A measurement of 300°/s in the larger sample differentiated the control group from the MAS 1, 1+, and 2 subgroups (p < 0.01), as well as the MAS 1 and 2 subgroups (p < 0.05). No fixed or proportional bias was observed in repeated measurements. Conclusion: A simple mechanical measurement methodology was developed based on the analysis of the clinical maneuver for measuring spasticity and was shown to be valid in differentiating the existence and extent of spasticity. This study suggest possible requirements to improve the quality of the mechanical measurement of spasticity.

Requirements for Eliciting a Spastic Response With Passive Joint Movements and the Influence of Velocity on Response Patterns: An Experimental Study of Velocity-Response Relationships in Mild Spasticity With Repeated-Measures Analysis.

Background: Spasticity is defined as a velocity-dependent increase in tonic stretch reflexes and is manually assessed in clinical practice. However, the best method for the clinical assessment of spasticity has not been objectively described. This study analyzed the clinical procedure to assess spasticity of the elbow joint using an electrogoniometer and investigated the appropriate velocity required to elicit a spastic response and the influence of velocity on the kinematic response pattern. Methods: This study included eight healthy individuals and 15 patients with spasticity who scored 1 or 1+ on the modified Ashworth Scale (MAS). Examiners were instructed to manually assess spasticity twice at two different velocities (slow and fast velocity conditions). During the assessment, velocity, deceleration value, and angle [described as the % range of motion (%ROM)] at the moment of resistance were measured using an electrogoniometer. Differences between the slow and fast conditions were evaluated. In addition, variations among the fast condition such as the responses against passive elbow extension at <200, 200-300, 300-400, 400°/s velocities were compared between the MAS 1+, MAS 1, and control groups. Results: Significant differences were observed in the angular deceleration value and %ROM in the fast velocity condition (417 ± 80°/s) between patients and healthy individuals, but there was no difference in the slow velocity condition (103 ± 29°/s). In addition, the deceleration values were significantly different between the MAS 1 and MAS 1+ groups in velocity conditions faster than 300°/s. In contrast, the value of %ROM plateaued when the velocity was faster than 200°/s. Conclusion: The velocity of the passive motion had a significant effect on the response pattern of the elbow joint. The velocity-response pattern differed between deceleration and the angle at which the catch occurred; the value of deceleration value for passive motion was highly dependent on the velocity, while the %ROM was relatively stable above a certain velocity threshold. These results provide clues for accurate assessment of spasticity in clinical practice.

Effects of ankle-foot orthoses on the stability of post-stroke hemiparetic gait.

BACKGROUND: Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability. AIM: To investigate the effects of ankle-foot orthoses on post-stroke gait stability. DESIGN: An experimental study with repeated measurements of gait parameters with and without orthosis. SETTING: Inpatients and outpatients in the Fujita Health University Hospital, Toyoake, Japan. POPULATION: Thirty-two patients (22 males; mean age 48.3±20.0 years) with post-stroke hemiparesis participated in the study. METHODS: Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared. RESULTS: In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041). CONCLUSIONS: Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated. CLINICAL REHABILITATION IMPACT: Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.

The urbanisation-environment conflict: Insights from material stock and productivity of transport infrastructure in Hanoi, Vietnam.

Developing regions experience rapid population growth and urbanisation, which require large quantities of materials for civil infrastructure. The production of construction materials, especially for urban transport systems, however, contributes to local and global environmental change. Political agendas may overlook the environmental implications of urban expansion, as economic growth tends to be prioritised. While elevating the standard of living is imperative, decision-making without careful environmental assessments can undermine the overall welfare of society. In this study, we evaluate the material demand and in-use stock productivity for the large-scale development plan for transport infrastructure in the city of Hanoi, Vietnam, from 2010 to 2030, combining geospatial and socioeconomic data with statistics on roads and railways. The results show that the total material stock could rise threefold from 66 Tg in 2010 to 269 Tg in 2030, which roughly translates to an addition of 30 Empire State Buildings per year by mass. The materials we account are required for construction exceed the availability of local sand and will need to be gathered farther away. Furthermore, the material stock productivity of the transport infrastructure appears to have been declining overall since 2010, and this trend may continue to 2030. These findings demonstrate the importance of informing urban planning with a comprehensive assessment of construction materials demand, supply capacity, and environmental impacts. Policy priorities for improving the in-use stock productivity are also recommended towards achieving a more efficient utilisation of natural resources.

High-Resolution Maps of Material Stocks in Buildings and Infrastructures in Austria and Germany.

The dynamics of societal material stocks such as buildings and infrastructures and their spatial patterns drive surging resource use and emissions. Two main types of data are currently used to map stocks, night-time lights (NTL) from Earth-observing (EO) satellites and cadastral information. We present an alternative approach for broad-scale material stock mapping based on freely available high-resolution EO imagery and OpenStreetMap data. Maps of built-up surface area, building height, and building types were derived from optical Sentinel-2 and radar Sentinel-1 satellite data to map patterns of material stocks for Austria and Germany. Using material intensity factors, we calculated the mass of different types of buildings and infrastructures, distinguishing eight types of materials, at 10 m spatial resolution. The total mass of buildings and infrastructures in 2018 amounted to ∼5 Gt in Austria and ∼38 Gt in Germany (AT: ∼540 t/cap, DE: ∼450 t/cap). Cross-checks with independent data sources at various scales suggested that the method may yield more complete results than other data sources but could not rule out possible overestimations. The method yields thematic differentiations not possible with NTL, avoids the use of costly cadastral data, and is suitable for mapping larger areas and tracing trends over time.

Validity of quantitative assessment of posterior pelvic tilt and contralateral vaulting in hemiplegia using 3D treadmill gait analysis.

BACKGROUND: Assessing abnormal gait patterns could indicate compensatory movements, which could be an index for recovery and a process of motor learning. To quantify the degree of posterior pelvic tilt, contralateral vaulting is necessary. OBJECTIVES: This study aimed to develop and evaluate the validity of quantitative indices for posterior pelvic tilt and contralateral vaulting in hemiplegic patients. METHODS: Forty-six healthy control subjects and 112 hemiplegic patients participated in this study. Of the 112 patients, 50 were selected into each abnormal gait pattern group, with some overlap. Three experienced physical therapists observed their walking and graded the severity of the two abnormalities in five levels. An index to quantify each of the two abnormal gait patterns was calculated from the three-dimensional treadmill gait analysis. The index values of patients were compared with those of healthy subjects and with the results of observational gait assessment done by three physical therapists with expertise in gait analysis. RESULTS: The index values were significantly higher in hemiplegic patients than in healthy subjects (28.0% and 44.7% for the posterior pelvic tilt in healthy subjects and patients, respectively and 0.9 and 4.7 for the contralateral vaulting, respectively). A strong correlation was observed between the index value and the median observational rating for two abnormal gait patterns (r = -0.68 and -0.72). CONCLUSIONS: The proposed indices for posterior pelvic tilt and contralateral vaulting are useful for clinical gait analysis, and thus encouraging a more detailed analysis of hemiplegic gait using a motion analysis system.

Persistent Effect of Gait Exercise Assist Robot Training on Gait Ability and Lower Limb Function of Patients With Subacute Stroke: A Matched Case-Control Study With Three-Dimensional Gait Analysis.

INTRODUCTION: Gait exercise assist robot (GEAR), a gait rehabilitation robot developed for poststroke gait disorder, has been shown to improve walking speed and to improve the poststroke gait pattern. However, the persistence of its beneficial effect has not been clarified. In this matched case-control study, we assessed the durability of the effectiveness of GEAR training in patients with subacute stroke on the basis of clinical evaluation and three-dimensional (3D) gait analysis. METHODS: Gait data of 10 patients who underwent GEAR intervention program and 10 patients matched for age, height, sex, affected side, type of stroke, and initial gait ability who underwent conventional therapy were extracted from database. The outcome measures were walk score of Functional Independence Measure (FIM-walk), Stroke Impairment Assessment Set total lower limb motor function score (SIAS-L/E), and 3D gait analysis data (spatiotemporal factors and abnormal gait patter indices) at three time points: baseline, at the end of intervention, and within 1 week before discharge. RESULTS: In the GEAR group, the FIM-walk score, SIAS-L/E score, cadence, and single stance time of paretic side at discharge were significantly higher than those at post-training (p < 0.05), whereas the stance time and double support time of the unaffected side, knee extensor thrust, insufficient knee flexion, and external rotated hip of the affected side were significantly lower (p < 005). However, no significant differences in these respects were observed in the control group between the corresponding evaluation time points. CONCLUSION: The results indicated significant improvement in the GEAR group after the training period, with respect to both clinical parameters and the gait pattern indices. This improvement was not evident in the control group after the training period. The results possibly support the effectiveness of GEAR training in conferring persistently efficient gait patterns in patients with poststroke gait disorder. Further studies should investigate the long-term effects of GEAR training in a larger sample.

Effects of Repetitive Peripheral Magnetic Stimulation on Shoulder Subluxations Caused by Stroke: A Preliminary Study.

OBJECTIVES: Shoulder subluxation is a common problem after stroke. It causes shoulder pain that affects activities of daily living. This study aimed to investigate the effect of repetitive peripheral magnetic stimulation on shoulder subluxation after stroke. METHODS: We enrolled 12 consecutive patients who, as a result of stroke, suffered shoulder subluxations, measuring at half of a fingerbreadth or more. All subjects underwent conventional rehabilitation, as well as repetitive peripheral magnetic stimulation of their supraspinatus, posterior deltoid, and infraspinatus muscles. We assessed the following parameters: shoulder subluxation, evaluated as the acromio-humeral interval using measurements taken from X-rays; shoulder pain, evaluated using the Numerical Rating Scale; the active range of motion of shoulder abduction; and the motor impairment of the upper extremities, evaluated using the upper extremity of the Fugl-Meyer Assessment scale. RESULTS: The acromio-humeral interval before treatment was 22.8 ± 5.7 mm (mean ± SD). It significantly decreased to 19.6 ± 7.0 mm (p = 0.004) after treatment. Shoulder pain (p = 0.039), active range of motion of shoulder abduction (p = 0.016), and total (p = 0.005), subscale A (p = 0.005), and subscale C (p = 0.008) Fugl-Meyer Assessment scores also improved significantly after treatment. CONCLUSIONS: Repetitive peripheral magnetic stimulation effectively reduced shoulder subluxations and shoulder pain caused by stroke and improved voluntary upper-limb movements in stroke patients.

The effect of using Gait Exercise Assist Robot (GEAR) on gait pattern in stroke patients: a cross-sectional pilot study.

Background: The Gait Exercise Assist Robot (GEAR) has been developed to support gait training for stroke patients. The GEAR can assist paretic lower limb swing and stance stability, which make it possible to practice walking without excessive compensation movements. However, there are no studies to-date that investigate the effect of the GEAR on gait pattern.Objectives: The purpose of this study was to clarify the effect of gait training on gait pattern using the GEAR for rehabilitation in stroke patients.Methods: Fifteen hemiplegic patients who received gait training using the GEAR were recruited (GEAR group). As a control group, hemiplegic patients who did not receive gait training using the GEAR were selected for each patient in the GEAR group from 114 cases in our hospital database. Primary outcomes were index values indicating the degree of 10 abnormal gait patterns. Secondary outcomes were spatiotemporal factors and comfortable overground gait velocity.Results: Index values for abnormal gait patterns were significantly lower in the GEAR group compared to the control group for insufficient knee flexion during the swing phase, hip hiking, and excessive lateral shift of the trunk over the unaffected-side (p < .05). The comfortable overground gait velocity, stride length, and unaffected-step length in the GEAR group were significantly better than in the control group (p < .05).Conclusions: Gait training using the GEAR had effects on reducing abnormal gait patterns and improving gait velocity, stride, and unaffected-side step length compared to conventional gait training alone in individuals recovering from stroke-induced hemiplegia.

Gait characteristics of post-stroke hemiparetic patients with different walking speeds.

Hemiparesis resulting from stroke presents characteristic spatiotemporal gait patterns. This study aimed to clarify the spatiotemporal gait characteristics of hemiparetic patients by comparing them with height-, speed-, and age-matched controls while walking at various speeds. The data on spatiotemporal gait parameters of stroke patients and that of matched controls were extracted from a hospital gait analysis database. In total, 130 pairs of data were selected for analysis. Patients and controls were compared for spatiotemporal gait parameters and the raw value (RSI) and absolute value (ASI) of symmetry index and coefficient of variation (CV) of these parameters. Stroke patients presented with prolonged nonparetic stance (patients vs. controls: 1.01 ± 0.41 vs. 0.83 ± 0.25) and paretic swing time (0.45 ± 0.12 vs. 0.39 ± 0.07), shortened nonparetic swing phase (0.35 ± 0.07 vs. 0.39 ± 0.07), and prolonged paretic and nonparetic double stance phases [0.27 ± 0.13 (paretic)/0.27 ± 0.17 (nonparetic) vs. 0.22 ± 0.10]. These changes are especially seen in low-gait speed groups (<3.4 km/h). High RSIs of stance and swing times were also observed (-9.62 ± 10.32 vs. -0.79 ± 2.93, 24.24 ± 25.75 vs. 1.76 ± 6.43, respectively). High ASIs and CVs were more generally observed, including the groups with gait speed of ≥3.5 km/h. ASI increase of the swing phase (25.79 ± 22.69 vs. 4.83 ± 4.88) and CV of the step length [7.7 ± 4.9 (paretic)/7.6 ± 5.0 (nonparetic) vs. 5.3 ± 3.0] were observed in all gait speed groups. Our data suggest that abnormalities in the spatiotemporal parameters of hemiparetic gait should be interpreted in relation to gait speed. ASIs and CVs could be highly sensitive indices for detecting gait abnormalities.

Quantitative Eye Gaze and Movement Differences in Visuomotor Adaptations to Varying Task Demands Among Upper-Extremity Prosthesis Users.

Importance: New treatments for upper-limb amputation aim to improve movement quality and reduce visual attention to the prosthesis. However, evaluation is limited by a lack of understanding of the essential features of human-prosthesis behavior and by an absence of consistent task protocols. Objective: To evaluate whether task selection is a factor in visuomotor adaptations by prosthesis users to accomplish 2 tasks easily performed by individuals with normal arm function. Design, Setting, and Participants: This cross-sectional study was conducted in a single research center at the University of Alberta, Edmonton, Alberta, Canada. Upper-extremity prosthesis users were recruited from January 1, 2016, through December 31, 2016, and individuals with normal arm function were recruited from October 1, 2015, through November 30, 2015. Eight prosthesis users and 16 participants with normal arm function were asked to perform 2 goal-directed tasks with synchronized motion capture and eye tracking. Data analysis was performed from December 3, 2018, to April 15, 2019. Main Outcome and Measures: Movement time, eye fixation, and range of motion of the upper body during 2 object transfer tasks (cup and box) were the main outcomes. Results: A convenience sample comprised 8 male prosthesis users with acquired amputation (mean [range] age, 45 [30-64] years), along with 16 participants with normal arm function (8 [50%] of whom were men; mean [range] age, 26 [18-43] years; mean [range] height, 172.3 [158.0-186.0] cm; all right handed). Prosthesis users spent a disproportionately prolonged mean (SD) time in grasp and release phases when handling the cups (grasp: 2.0 [2.3] seconds vs 0.9 [0.8] seconds; P < .001; release: 1.1 [0.6] seconds vs 0.7 [0.4] seconds; P < .001). Prosthesis users also had increased mean (SD) visual fixations on the hand for the cup compared with the box task during reach (10.2% [12.1%] vs 2.2% [2.8%]) and transport (37.1% [9.7%] vs 22.3% [7.6%]). Fixations on the hand for both tasks were significantly greater for prosthesis users compared with normative values. Prosthesis users had significantly more trunk flexion and extension for the box task compared with the cup task (mean [SD] trunk range of motion, 32.1 [10.7] degrees vs 21.2 [3.7] degrees; P = .01), with all trunk motions greater than normative values. The box task required greater shoulder movements compared with the cup task for prosthesis users (mean [SD] flexion and extension; 51.3 [12.6] degrees vs 41.0 [9.4] degrees, P = .01; abduction and adduction: 40.5 [7.2] degrees vs 32.3 [5.1] degrees, P = .02; rotation: 50.6 [15.7] degrees vs 35.5 [10.0] degrees, P = .02). However, other than shoulder abduction and adduction for the box task, these values were less than those seen for participants with normal arm function. Conclusions and Relevance: This study suggests that prosthesis users have an inherently different way of adapting to varying task demands, therefore suggesting that task selection is crucial in evaluating visuomotor performance. The cup task required greater compensatory visual fixations and prolonged grasp and release movements, and the box task required specific kinematic compensatory strategies as well as increased visual fixation. This is the first study to date to examine visuomotor differences in prosthesis users across varying task demands, and the findings appear to highlight the advantages of quantitative assessment in understanding human-prosthesis interaction.

The Effect of an Automatically Levelling Wrist Control System.

Upper limb loss is a devastating injury for which current prosthetic replacement inadequately compensates. A lack of wrist movement in prostheses due to mechanical design and control system considerations compels prosthetic users to employ compensatory movements using their upper back and shoulder that can eventually result in strain and overuse injuries. One possible means of easing this control burden is to allow a prosthetic wrist to self-regulate, keeping the terminal device of the prosthesis level relative to the ground when appropriate, such as when raising a cup of liquid. This study aims to outline such a wrist control scheme, and evaluate its function in terms of the effect on compensatory movements, objective system performance, and subjective perception of system performance based on user feedback. To that end, twelve able-bodied participants were recruited to control a body-mounted robotic arm using three different control schemes: fixed-wrist (FW), sequential switching (SS), and automatic levelling (AL). The resulting movement strategies were recorded for two different tasks using 3D motion-capture. SS and AL control schemes induced similar movement strategies and less compensation than FW for horizontal movements, while AL reduced shoulder flexion compared to FW and SS for vertical movements. However, AL was ranked less intuitive and less reliable than the FW. AL and SS both seemed to involve more conscious thought to operate than FW. These results suggest that more complex wrist control schemes may indeed be able to eliminate harmful compensatory movements, but reinforce prior observations that control must be reliable and simple to use or people will opt for an easier system.

Upper Limb Motor Function Affects the Outcome after Treatment with Botulinum Toxin A.

BACKGROUND: Treatment with Botulinum toxin A (BoNT-A) is effective in decreasing upper limb spasticity. OBJECTIVE: This study aimed to determine the differences in the outcome based on the upper limb motor function before BoNT-A treatment. METHODS: The subjects were 61 patients who underwent BoNT-A treatment for upper limb spasticity. Limb function was evaluated using the Fugl-Meyer Assessment upper extremity (FMA-UE), modified Ashworth scale, passive range of motion and disability assessment scale before treatment as well as 2, 6, and 12 weeks after treatment. We divided the total and each subscale of FMA-UE before BoNT-A administration into beyond-the-mean-score group (higher score group) and below-the-mean-score group (lower score group). RESULTS: In both the higher and lower score groups of the FMA-UE total and modified Ashworth scale scores improved significantly after treatment. In FMA-UE, the higher score group of subscale A improved significantly, but subscale C decreased significantly at 2 and 6 weeks after the administration. The lower score group of total, subscale A, and B improved significantly. In the disability assessment scale, the self-dressing capability at 6 weeks and limb position at 2, 6 and 12 weeks after the administration improved significantly in the higher score group. In the lower score group, the hygiene capability at 2 weeks as well as the dressing capability and limb position improved significantly at 2, 6 and 12 weeks after administration. CONCLUSIONS: The time course after administration of BoNT-A differed based on upper limb motor function before injection. When administering BoNT-A into the finger flexor muscles of a patient, we should carefully judge the indications for administration.

Quantitative assessment of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip in hemiplegia using three-dimensional treadmill gait analysis.

BACKGROUND: Most people with hemiplegia experience gait changes after a stroke. Abnormal gait patterns in stroke patients vary across subjects and this make it difficult to assess the cause of gait abnormalities. Therefore, it is necessary to quantitatively evaluate abnormal gait patterns through gait analysis for stroke patients. OBJECTIVE: To develop and evaluate the validity of quantitative assessments of the degree of knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip. METHODS: Forty-six healthy control subjects and 112 people with hemiplegia participated. From the 112 patients, 50 patients were selected into each abnormal gait pattern (knee extensor thrust, flexed-knee gait, insufficient knee flexion during the swing phase, and medial whip) with some overlap. Participants were instructed to walk on a treadmill and were recorded using a three-dimensional motion analysis system. An index to quantify each of the four abnormal gait patterns exhibited by the patients was calculated from the three-dimensional coordinate data. The indices were developed based on the definition of the abnormal gait patterns. The index values for the patients were compared with those of healthy subjects as well as with the results of observational gait assessment by three physical therapists with expertise in gait analysis. RESULTS: Strong correlation was observed between the index value and the median observational rating for all four abnormal gait patterns (-0.64 to -0.86). Most of the patients with an abnormal gait pattern had a higher index value than the healthy subjects. CONCLUSIONS: The use of these indices in gait analysis of people with hemiplegia can help to diagnose severity of gait disorder, determine the appropriate treatment, and evaluate the effectiveness of the treatment.