O uso da ETCC associado ao treino motor de membros inferiores na neurologia: revisão sistemática da literatura / The use of transcranial direct current stimulation combined with lower limb motor training in neurology: A systematic review of the literature

Introdução: A estimulação Transcraniana por corrente contínua (ETCC) é uma técnica neuromodulatória que pode alterar um padrão de excitabilidade mal adaptativo frente á uma lesão neurológica. Seu uso combinado com o treino motor vem sendo amplamente discutido na literatura. Objetivo: realizar uma revisão de estudos que utilizaram a ETCC combinada com treinos físicos de membros inferiores para melhora da marcha, equilíbrio e controle postural de pacientes neurológicos. Método: Foi realizada uma revisão bibliográfica nas bases de dados: Medline, Lilacs, Embase, Physiotherapy Evidence Database, Cochrane databases, Cinahl, Scielo e PubMed.Os artigos utilizados nesta revisão foram pontuados e qualificados através da escala Physiotherapy Evidence Database. Resultados:Foram incluídos no estudo 9 artigos combinando o uso da ETCC a treinos motores de membros inferiores. Conclusão: Os resultados dos estudos mostram que embora ainda não exista uma padronização dos parâmetros ideais de utilização da ETCC, sugerimos que seu uso combinado com treino motor pode potencializar os efeitos funcionais da terapia.

Background: Transcranial direct current stimulation (tDCS) is a neuromodulatory stimulation technique that can modulate a maladaptive excitation pattern against neurological injury. The combined use of this technique with physical rehabilitation has been widely discussed in the literature. Objective: To conduct a review of studies that employed the tDCS combined with lower limb training to improve gait, balance and postural control in neurological patients. Methods: A bibliographic review was performed in the databases: Medline, Lilacs, Embase, Physiotherapy Evidence Database, Cochrane databases, Cinahl, Scielo and PubMed.Selected articles were scored and qualified based on the Physiotherapy Evidence Database scale. Results: Nine studies involving the combination of tDCS and lower limb motor training for individuals with neurological problems were included. Conclusion: Despite being widely studied scientifically, no general consensus is yet found in the literature regarding the ideal tDCS administration parameters, we suggest that the combined use with motor training may potentiate the functional effects of therapy.

Ação do exercício de subida em escada com sobrecarga na morfologia do músculo tibial anterior de ratos Wistars após axonotmese / Action of the climbing ladder exercise with overload in the morphology of the anterior tibial muscle of wistars rats after axonotmesis

Objetivo: avaliar histomorfometrica e morfologicamente o músculo tibial anterior de ratos submetidos à axonotmese e tratados com exercício. Métodos: foram randomizados 28 ratos Wistar nos grupos controle (GC), exercício (GE), lesão (GL) e lesão+exercício (GLE). No terceiro dia após compressão, GE e GLE realizaram exercício de subida em escada, com duas séries de dez repetições. Após 21 dias, o músculo tibial anterior foi processado para microscopia de luz. Resultados: Na análise morfológica GC apresentou morfologia com aspecto característico, GE hipertrofia muscular, GL alterações morfológicas, como fibras polimórficas e núcleos centrais, e GLE aspecto semelhante ao controle, porém com algumas alterações. Na área de secção transversa e menor diâmetro das fibras GC e GE apresentaram valores maiores, o inverso da análise de vasos sanguíneos. Para o tecido conjuntivo, GE apresentou-se menor que o GL. Conclusão: O protocolo de exercício promoveu melhora nos aspectos histomorfológicos, mas não reverteu totalmente os efeitos deletérios. (AU)

Objective: to evaluate morphologically the tibialis anterior muscle of rats submitted to axonotmosis and treated with exercise. Methods: 28 Wistar rats were used in groups control (CG), exercise (GE), injury (GL) and injury + exercise (GLE). On the third day after compression, GE and GLE performed climb exercise staircase, with two sets of ten repetitions. After 21 days, the muscle was processed for light microscopy. Results: In the morphological analysis GC presented with morphology characteristic appearance, GE muscle hypertrophy, GL morphological changes like polymorphic fibers and central nucleo, and GLE look similar to the control, but with some changes morphological. In the cross-sectional area and smaller diameter of the GC and GE fiber showed higher values, inversed analysis of blood vessels. For the connective tissue, GE was lower than the GL. Conclusion: Summing up, the exercise promoted improvement in morphological aspects, but not totally reversed the deleterious effects of denervation. (AU)

Hospital discharge of patients with disabling neurological injury: necessary referrals to rehabilitation. / Alta hospitalar de clientes com lesão neurológica incapacitante: impreteríveis encaminhamentos para reabilitação.

The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients' autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient's home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.

Alta hospitalar de clientes com lesão neurológica incapacitante: impreteríveis encaminhamentos para reabilitação / Hospital discharge of patients with disabling neurological injury: necessary referrals to rehabilitation

Resumo Trata-se de pesquisa de abordagem qualitativa realizada no segundo semestre de 2014, mediante entrevistas com 12 médicos e 13 enfermeiros gestores atuantes em Hospital de grande porte, referência na área de urgência e emergência para a Zona da Mata Mineira. Buscou identificar os critérios utilizados por médicos e enfermeiros para o preparo da alta de pessoas com lesão neurológica incapacitante e indicação para acesso a programa de reabilitação física. Para o tratamento dos dados, utilizou-se a técnica de Análise de Conteúdo, modalidade temática. Os resultados mostram que os gestores hospitalares ainda encontram dificuldades para proceder ao encaminhamento adequado dessas pessoas para serviços especializados de reabilitação, o que compromete a autonomia e independência para o autocuidado. Conclui-se que os gestores além de envolver cuidadores e familiares no preparo da alta de pessoas com lesão neurológica que resulta em incapacidades para o autocuidado, deveriam avaliar as condições de acessibilidade em seus domicílios e fazer encaminhamentos adequados para serviços de reabilitação disponíveis na comunidade, a despeito da pouca divulgação acerca dos fluxos da Rede de Cuidados da Pessoa com Deficiência.

Abstract The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients’ autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient’s home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.

Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation.

Pathological neural activity could be treated by directing specific plasticity to renormalize circuits and restore function. Rehabilitative therapies aim to promote adaptive circuit changes after neurological disease or injury, but insufficient or maladaptive plasticity often prevents a full recovery. The development of adjunctive strategies that broadly support plasticity to facilitate the benefits of rehabilitative interventions has the potential to improve treatment of a wide range of neurological disorders. Recently, stimulation of the vagus nerve in conjunction with rehabilitation has emerged as one such potential targeted plasticity therapy. Vagus nerve stimulation (VNS) drives activation of neuromodulatory nuclei that are associated with plasticity, including the cholinergic basal forebrain and the noradrenergic locus coeruleus. Repeatedly pairing brief bursts of VNS sensory or motor events drives robust, event-specific plasticity in neural circuits. Animal models of chronic tinnitus, ischemic stroke, intracerebral hemorrhage, traumatic brain injury, and post-traumatic stress disorder benefit from delivery of VNS paired with successful trials during rehabilitative training. Moreover, mounting evidence from pilot clinical trials provides an initial indication that VNS-based targeted plasticity therapies may be effective in patients with neurological diseases and injuries. Here, I provide a discussion of the current uses and potential future applications of VNS-based targeted plasticity therapies in animal models and patients, and outline challenges for clinical implementation.

Factors Predicting the Effects of Hybrid Assistive Limb Robot Suit during the Acute Phase of Central Nervous System Injury.

To improve the activities of daily living of patients with injury to the central nervous system, physical therapy starting from the acute phase of the injury is important. Recently, the efficacy of physical therapy using a hybrid assistive limb (HAL) robot suit was reported. However, individual differences exist in the effects of HAL. We investigated factors predicting the effects of HAL in 15 patients at our institution with central nervous system injury, primarily due to stroke, who underwent training using HAL during the acute phase. Patients were classified as either "with HAL suitability" or "without HAL suitability" based on scores from 10-m walking speed, gait, satisfaction, and pain. In both groups, Brunnstrom stage before HAL intervention, Fugl-Meyer assessment (FMA), stroke impairment assessment set (SIAS), and functional independence measure (FIM) were evaluated. Although motor function items did not differ significantly, FIM cognitive function items (P = 0.036), visuospatial perception items on SIAS (P = 0.0277), and pain items on SIAS (P = 0.0122) differed significantly between groups. These results indicated that training using HAL does not involve pain in patients with central nervous system injury during the acute phase, and exhibits positive effects in patients without pain and with high communication ability and visuospatial perception function. When conducting HAL intervention, incorporating functional assessment scores (FIM and SIAS), including peripheral items, may be useful to predict the suitability of HAL.

The implications of injury in the developing nervous system on upper extremity function.

STUDY DESIGN: Literature review. PURPOSE: The corticospinal system (CS) and peripheral nervous system (PNS) are common sites of damage during the early stages of life. The prenatal or immediately prenatal period is the most common time for damage to occur. Here we briefly review the basic features of the development of the CS and the PNS and the clinical consequences of injury to or improper development of these systems on upper extremity (UE) function. RESULTS: The proper development of both the CS and PNS is necessary to achieve adequate function of the (UE). Injury or improper development of these systems can lead to upper extremity dysfunction and limit participation in activities of daily living. CONCLUSIONS: Both the PNS and CS play major roles in the proper functioning of the UE. A better understanding of their roles and common developmental disorders is needed to move rehabilitation of motor impairments forward.

Service dogs in the province of Quebec: sociodemographic profile of users and the dogs' impact on functional ability.

PURPOSE: The objectives of this study were to (1) describe the sociodemographic profile of service dog users, their physical disabilities, main occupations, living environment, and use of technical aids in daily life and (2) evaluate the impact of service dogs on wheelchair travel and picking up objects. METHOD: Sociodemographic and clinical data were collected and various mobility tests were conducted in the service dog users' home environment (n = 199). RESULTS: The service dog users had injuries to the central or peripheral nervous system (55%), spinal cord (33%), or musculoskeletal or orthopedic system (12%). In the wheelchair travel on flat terrain test (n = 67), users travelled a longer distance in a shorter time, improving their average speed to 1.28 m/s with the service dog compared to 0.75 m/s without (p < 0.001). In a wheelchair propelling up a slope, 42% improved with the service dog (n = 60). Mounting a threshold/curb in a wheelchair, 41% improved with the service dog (n = 39). In a test where walkers and wheelchair users picked up three objects off the ground, 44% improved with the service dog (n = 164). CONCLUSION: Service dogs significantly improved wheelchair travel speed and distance on flat and ascending terrain, mounting a threshold/curb and picking up objects off the ground. Implications for Rehabilitation For people with motor impairments: Service dogs are most often used as a technical aid to pick up objects (96%), open doors (36%) and pull the wheelchair during travel (34%). Clients' performance in significant travel in a wheelchair (on flat terrain, on an upslope, mounting a threshold) improved with the service dog compared to their own performance without the dog. Clients' grasping performance (picking up three significant objects off the ground) improved with the service dog compared to their own performance without the dog.

Brain-computer interface after nervous system injury.

Brain-computer interface (BCI) has proven to be a useful tool for providing alternative communication and mobility to patients suffering from nervous system injury. BCI has been and will continue to be implemented into rehabilitation practices for more interactive and speedy neurological recovery. The most exciting BCI technology is evolving to provide therapeutic benefits by inducing cortical reorganization via neuronal plasticity. This article presents a state-of-the-art review of BCI technology used after nervous system injuries, specifically: amyotrophic lateral sclerosis, Parkinson's disease, spinal cord injury, stroke, and disorders of consciousness. Also presented is transcending, innovative research involving new treatment of neurological disorders.

Medical tourism: evidence from an Italian descriptive survey on pediatric neurorehabilitation treatment abroad.

BACKGROUND: In recent years we have witnessed a rapidly-growing tendency to seek neurorehabilitation abroad. AIM: This study aimed at better understanding this practice through a analysis of the authorizations for pediatric neurorehabilitation services issued by Italian Regions. DESIGN: Descriptive retrospective survey study. SETTING: Outpatient. POPULATION: Italian children travelling abroad for neurorehabilitation. METHODS: We analyzed the number of authorizations granted in the 2008-2011 period by local health agencies of Italian regions to children aged 0-18 years applying for neurorehabilitation services abroad. Information was obtained from the Ministry of Health database management systems. RESULTS: Our analysis showed an extreme variability across Italian regions. This is probably suggestive of an unbalanced offer of pediatric neurorehabilitation services across regions, different mechanisms used to control the phenomenon. CONCLUSION: Our study looked specifically at the practice of neurorehabilitation abroad in order to encourage further and larger studies, even at international level. A greater integration of health systems with common policies is to be achieved in order to control this phenomenon in a field as sensitive as pediatric neurorehabilitation. CLINICAL REHABILITATION IMPACT: Our study, which is the only study so far focusing on pediatric neurorehabilitation, looked specifically at the practice of health tourism in order to encourage further and larger studies, even at international level. Health tourism is a critical issue for all Western welfare systems which are under a pressure to cut health-related expenses.

Neurotrauma outside the high-income setting: a review of audit and data-collection strategies.

OBJECTIVE: To review the sparse literature that exists on the topic of head injury assessment and management outside high-income settings and attempt to: 1) identify strengths and weaknesses of the currently published clinical data relating to head injuries in lower-income countries; and 2) consider specific objectives for future head injury research in the resource-limited setting. If levels of excellence in neurosurgery are to be sustainably achieved outside high-income countries, there must be good systems of research and audit in place both to identify where development is needed and to evaluate the efficacy of development projects already in progress. METHODS: We performed a MEDLINE search of publications between 1980 and 2010 by using the search terms head injuries/craniocerebral trauma/neurotrauma and developing world/developing nations. Information was extracted and compared between publications by using our local head injury evaluation and audit database (OxHEAD) as a quality standard. RESULTS: The issue of traumatic brain injury management in low-income countries is underrepresented in the international literature relative to the scale of the problem. However, epidemiologic data generally are better reported than data relating to in-hospital care and follow-up, which suffers as a result of heterogeneous data collection and categorization techniques. CONCLUSION: The use of standardized scoring systems and outcome measures is likely to improve the comparability of data between studies. A multicenter collaborative approach towards data collection in resource-limited settings may be the most efficient and productive strategy for future research.

New therapeutic advances in CNS injury and repair.

The 9th Global College of Neuroprotection and Neuroregeneration annual meeting was held in cooperation with the 5th International Association of Neurorestoratology and the 4th International Spinal Cord Injury Treatment and Trial Symposium in the beautiful city of Xi'an, Shaanxi Province, China, between 4 and 7 May 2012. This trilateral conference was held in the pleasing ambience of the Sofitel Hotel Complex in Renmin Square, Xi'an. Top Chinese government dignitaries including the National Deputy Health Minister, Vice Governor of Shaanxi Province, Vice President of Xi'an Jiaotong University and Party Secretary of the Medical Association inaugurated the congress. More than 1000 delegates from across the world, including approximately 600 medical researchers from China, participated in this meeting. The theme of this meeting was 'neurorestoration and neurorepair' using stem cell treatment, antibodies and pharmacotherapy, as well as nanomedicine and neurorehabilitation. Preclinical and clinical research was presented and discussed. Use of nanomedicine to enhance neurorepair or diagnosis of neurological diseases in clinical situations was the new attraction in this trilateral meeting. More than 50 leading experts in neuroprotection and neurorestoratology presented their cutting edge research in the area. New features included the Youth Forum in which 12 young scientists presented their innovative results, and more than 30 platform presentations were included. Thus, the trilateral conference of the Global College of Neuroprotection and Neuroregeneration, the International Association of Neurorestoratology and the International Spinal Cord Injury Treatment and Trial Symposium was extremely successful from both the scientific and social perspectives.

Neurorehabilitation: are we doing all that we can?

Occupational therapists have many intervention tools available for working with clients having a neurological injury; however, some of the most innovative and effective methods have not gained acceptance by many clinicians. Emerging research and new technologies provide occupational therapists with a multitude of treatment strategies and novel devices, but incorporation of those tools into clinical practice appears to be limited by the time necessary to learn about the intervention, educational requirements associated with implementation, or lack of awareness regarding the evidence supporting the use of such tools. Strategies to combat this trend include educating clinicians on evidence-based methods for neurological rehabilitation, aligning academics with practitioners to translate evidence into practical treatment strategies, and accepting that occupational therapy can use these innovations as a means toward state-of-the art, occupation-based practice.

Factors affecting outcome after traumatic limb amputation.

BACKGROUND: Traumatic leg amputation commonly affects young, active people and leads to poor long-term outcomes. The aim of this review was to describe common causes of disability and highlight therapeutic interventions that may optimize outcome after traumatic leg amputation. METHODS: A comprehensive search of MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature databases was performed, using the terms 'leg injury', 'amputation' and 'outcome'. Articles reporting outcomes following traumatic leg amputation were included. RESULTS: Studies demonstrated that pain, psychological illness, decreased physical and vocational function, and increased cardiovascular morbidity and mortality were common causes of disability after traumatic leg amputation. The evidence highlights that appropriate preoperative management and operative techniques, in conjunction with suitable rehabilitation and postoperative follow-up, can lead to improved treatment outcome and patient satisfaction. CONCLUSION: Patients who undergo leg amputation after trauma are at risk of poor long-term physical and mental health. Clinicians involved in their care have many opportunities to improve their outcome using a variety of therapeutic variables. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Advanced MR imaging techniques and characterization of residual anatomy.

Advances in technology in recent decades have contributed to rapid developments in non-invasive methods for imaging human anatomy, and advanced imaging methods are now one of the primary tools for clinical diagnosis after neurological trauma or disease. Here we review the current and upcoming capabilities of one of the most rapidly developing methods, magnetic resonance imaging (MRI). The underlying theory is introduced so that the reasons for the strengths, weaknesses, and future expectations of this method, can be explained. Current techniques for imaging anatomical changes, inflammation, and changes in white matter, axonal integrity, blood flow and function, are reviewed. Applications for specific purposes of assessing traumatic injury in the brain or spinal cord, and for multiple-sclerosis are also presented, and are used as examples of how the advanced techniques are being used in practice.

Restorative neurology: consideration of the new anatomy and physiology of the injured nervous system.

The adult human nervous system is an incredibly complex set of thousands to tens of thousands of connections between a hundred billion neurons that develops via an intricate spatial-temporal process and is shaped by experience. In addition, any one anatomical arrangement of neural circuits is usually capable of multiple physiological states. Following neurological injury, a new anatomy, and consequently a new spectrum of physiology, emerges within this nervous system with its mix of both injured and uninjured parts. It is this new combination of neural components that determines the extent to which natural functional recovery can occur and the extent to which clinical interventions can further that recovery. Detecting the new anatomy and physiology of the injured human nervous system is difficult but not impossible and some methods can track over time changes in neural structure or, more often, functions that correlate with neurological improvement. The goal of restorative neurology is to make best use of this new anatomy and physiology to facilitate neurological recovery. While we are still learning about how neurorehabilitation interventions generate functional recovery, we can begin to test hypothesis regarding the underlying mechanisms of neural plasticity and attempt to augment those processes.

Análise dos acidentes motociclísticos no Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER) / Analysis of motorcycle accidents at the Dr. Henrique Santillo Rehabilitation and Readaptation Center (CRER)

Introdução: na última década, dentre os acidentes automobilísticos, observa-se um número crescente envolvendo motocicletas, veículo que ganha cada vez mais aceitação e aprovação da população. Nestes acidentes, as lesões neurológicas mais freqüentes são o traumatismo cranioencefálico (TCE), seguido de lesão medular (LM), ambas de grande importância devido à gravidade das seqüelas que provocam. Objetivos: identificar o perfil dos pacientes vítimas de acidentes de tráfego com motocicletas no Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER), tipo de lesão neurológica, incapacidades adquiridas, reinserção laboral e capacidade para conduzir veículos após o trauma. Pacientes e métodos: realizou-se uma análise descritiva dos prontuários dos pacientes internados no CRER, no período de 2007 a 2010, selecionando apenas as vítimas de acidente motociclístico, assim como da atual situação produtiva dos mesmos através de contato telefônico no período de 01-07-2011 a 20-07-2011, utilizando formulário previamente elaborado. Resultados: houve predomínio de homens jovens economicamente ativos, sendo que a maioria não retornou sua vida laboral (86%) e está usufruindo de benefício previdenciário (79,6%). Conclusão: faz-se primordial a elaboração de estratégias para prevenção e controle dos traumas por motos, assim como medidas que estimulem a reinserção desses indivíduos incapacitados.

Introduction: in the last decade, among automobile accidents, it was observed that a growing number involved motorcycles, a vehicle that is beingmore and more accepted and approved by the population. In these accidentsthe most frequent neurological lesions are cranioencephalic trauma (CET), followed by medullary lesion (ML), both of great importance due to the gravity of their after-effects. Objectives: to identify the profile of the patients who are victims of motorcycle accidents at the Dr. Henrique Santillo Rehabilitation and Readaptation Center (CRER), their type of neurologicallesion, any acquired disabilities, their reinsertion into the job market, andtheir capacity to drive vehicles after the trauma. Patients and methods: a descriptive analysis of the medical history forms of patients admitted at CRER, from 2007 to 2010, selecting only the victims of motorcycle accidents, as well as the current productive situation of these victims through telephone contact between July 1st, 2011 and July 20th, 2011, utilizing apreviously-prepared form. Results: there was a predominance of youngmales economically active, the majority of whom did not return to work (86%) and are enjoying social welfare benefits (79.6%). Conclusion: The need to prepare strategies to prevent and control motorcycle traumas is evident, as well as measures that stimulate the reinsertion of these disabled individuals into the work market.

Physically interactive robotic technology for neuromotor rehabilitation.

Robotic technology can provide innovative responses to the severe challenges of providing cost-effective care to restore sensory-motor function following neurological and biomechanical injury. It may be deployed at several points on a continuum of care, to provide precisely controlled sensory-motor therapy to ameliorate disability and promote recovery of function, or to provide assistance to compensate for functions that cannot be recovered, or to replace limbs lost irretrievably. This chapter reviews recent progress using robotic technology to capitalize on neural plasticity and promote recovery after neurological injury such as stroke (cerebral vascular accident), research on brain-computer interfaces as a source of control signals for assistive technologies, and research on high-performance multiple-degree-of-freedom upper-extremity prosthetic limbs.

The influence of body weight support on ankle mechanics during treadmill walking.

The use of body weight support (BWS) systems during locomotor retraining has become routine in clinical settings. BWS alters load receptor feedback, however, and may alter the biomechanical role of the ankle plantarflexors, influencing gait. The purpose of this study was to characterize the biomechanical adaptations that occur as a result of a change in limb load (controlled indirectly through BWS) and gait speed during treadmill locomotion. Fifteen unimpaired participants underwent gait analysis with surface electromyography while walking on an instrumented dual-belt treadmill at seven different speeds (ranging from 0.4 to 1.6m/s) and three BWS conditions (ranging from 0% to 40% BWS). While walking, spatiotemporal measures, anterior/posterior ground reaction forces, and ankle kinetics and muscle activity were measured and compared between conditions. At slower gait speeds, propulsive forces and ankle kinetics were unaffected by changing BWS; however, at gait speeds ≥ approximately 0.8m/s, an increase in BWS yielded reduced propulsive forces and diminished ankle plantarflexor moments and powers. Muscle activity remained unaltered by changing BWS across all gait speeds. The use of BWS could provide the advantage of faster walking speeds with the same push-off forces as required of a slower speed. While the use of BWS at slower speeds does not appear to detrimentally affect gait, it may be important to reduce BWS as participants progress with training, to encourage maximal push-off forces. The reduction in plantarflexor kinetics at higher speeds suggests that the use of BWS in higher functioning individuals may impair the ability to relearn walking.

Rehabilitation of orthopaedic and neurologic boxing injuries.

Clinical decision making for injured boxers follows the same therapeutic principles as the treatment plan for other injured athletes. Just as surgical techniques have improved, so has the scientific basis for implementing therapeutic exercises progressed to return the athletes to their former level of competition.