The closed-loop control of rehabilitative technologies by neural commands has shown a great potential to improve motor recovery in patients suffering from paralysis. Brain-machine interfaces (BMI) ...can be used as a natural control method for such technologies. BMI provides a continuous association between the brain activity and peripheral stimulation, with the potential to induce plastic changes in the nervous system. Paraplegic patients, and especially the ones with incomplete injuries, constitute a potential target population to be rehabilitated with brain-controlled robotic systems, as they may improve their gait function after the reinforcement of their spared intact neural pathways. This paper proposes a closed-loop BMI system to control an ambulatory exoskeleton-without any weight or balance support-for gait rehabilitation of incomplete spinal cord injury (SCI) patients. The integrated system was validated with three healthy subjects, and its viability in a clinical scenario was tested with four SCI patients. Using a cue-guided paradigm, the electroencephalographic signals of the subjects were used to decode their gait intention and to trigger the movements of the exoskeleton. We designed a protocol with a special emphasis on safety, as patients with poor balance were required to stand and walk. We continuously monitored their fatigue and exertion level, and conducted usability and user-satisfaction tests after the experiments. The results show that, for the three healthy subjects, 84.44 ± 14.56% of the trials were correctly decoded. Three out of four patients performed at least one successful BMI session, with an average performance of 77.6 1 ± 14.72%. The shared control strategy implemented (i.e., the exoskeleton could only move during specific periods of time) was effective in preventing unexpected movements during periods in which patients were asked to relax. On average, 55.22 ± 16.69% and 40.45 ± 16.98% of the trials (for healthy subjects and patients, respectively) would have suffered from unexpected activations (i.e., false positives) without the proposed control strategy. All the patients showed low exertion and fatigue levels during the performance of the experiments. This paper constitutes a proof-of-concept study to validate the feasibility of a BMI to control an ambulatory exoskeleton by patients with incomplete paraplegia (i.e., patients with good prognosis for gait rehabilitation).
Background
Accumulation of bilirubin above normal levels is considered a neurological risk factor for both premature and full‐term newborns. This systematic review aimed to determine the effect of ...neonatal hyperbilirubinemia on neurodevelopment in preterm and full‐term newborns.
Methods
PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus and Lilacs databases were searched for articles published until 1 June 2022. The quality of cohort and case–control studies was assessed with the Newcastle–Ottawa Scale, and the MINCir scale was used to evaluate the methodological quality of therapy studies or the therapeutic procedures. Premature neonates without neurological conditions and those born at term with hyperbilirubinemia as the sole risk factor were included. Studies reporting one or more neurodevelopmental outcomes were included with an inter‐group comparison of a hyperbilirubinemia group versus a non‐hyperbilirubinemia or non‐pathological hyperbilirubinemia group. The main outcomes were auditory function, visual function, cognitive function, motor function, behavior, global development and neurological risk.
Results
The search identified 951 studies, 19 of which (n = 2210 newborns) were finally included. Fifteen of the cohort and case–control studies presented low risk of bias, and six studies showed high methodological quality. Within the preterm population, hyperbilirubinemia as the sole risk factor was not shown to affect neurodevelopment. Auditory, neurological and motor development alterations were found in the population of full‐term newborns with hyperbilirubinemia, which were more evident during the first year of life.
Conclusions
Elevated bilirubin levels may be a trigger for the onset of neurodevelopmental disorders in full‐term infants during the first year of life. More studies are warranted in the preterm population with hyperbilirubinemia to draw conclusions about its impact on their neurodevelopment.
Motor impairments are very common in neurological diseases such as multiple sclerosis. Noninvasive brain stimulation could influence the motor function of patients.
The aim of this meta-analysis was ...to evaluate the effectiveness of transcranial direct current stimulation (tDCS) on balance and gait ability in patients with multiple sclerosis. Additionally, a secondary aim was to compare the influence of the stimulation location of tDCS on current effectiveness.
A search was conducted for randomized controlled trials published up to May 2023 comparing the application of tDCS versus a sham or control group. The primary outcome variables were balance and gait ability.
Eleven studies were included in the qualitative analysis, and ten were included in the quantitative analysis, which included 230 patients with multiple sclerosis. The average effect of tDCS on gait functionality was superior to that of the control group (SMD = -0.71; 95% CI, -1.05 to -0.37). However, the overall results of the tDCS vs. sham effect on static balance did not show significant differences between groups (MD = 1.26, 95% CI, -1.31 to 3.82). No significant differences were found when different locations of tDCS were compared.
These results reveal that tDCS is an effective treatment for improving gait ability with a low quality of evidence. However, the application of tDCS has no effect on static balance in patients with multiple sclerosis with very low quality of evidence. Similarly, there seems to be no difference regarding the stimulation area with tDCS.
Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many ...clinical applications.
The aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy.
A search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included.
A total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson's disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment.
There are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.
One of the most frequent complications of breast cancer treatment is lymphoedema (LE), with lymphadenectomy and radiotherapy being the main triggers of this pathology in developed countries. The aim ...of the study was to determine the efficacy of therapeutic exercise in the prevention of upper limb (UL) lymphoedema evaluated through cirtometry, volumetry, or bioimpedance spectroscopy (BIS) in women after breast cancer removal surgery.
The Pubmed, PEDro, and Cochrane databases were consulted up to May 2020, including randomised clinical trials (RCTs) on therapeutic physical exercise as a possible preventive measure against breast cancer-related lymphoedema (BCRL). The studies were requested to have participants with UL lymphoedema and a control group.
A total of 304 articles were found, of which 9 were included (stand-alone studies). A therapeutic exercise program (strength and/or aerobic training) in women who had been surgically intervened for breast cancer may prevent lymphedema, compared to a regular care.
A therapeutic exercise program (strength and/or aerobic training) in women operated on for breast cancer contributes to reducing the number of cases that could obtain a greater difference in volume in their upper limbs, compared to a regular care program. However, further research is necessary to affirm that therapeutic physical exercise prevents BCRL.
Moderate-late preterm infants constitute the largest segment of preterm births globally. While previously considered to have a low neurological risk, recent research has uncovered an elevated ...incidence of neurodevelopmental conditions in this group. This study aimed to assess the relationship between the general movement assessment and birth-related risk factor-based tools in moderate-late preterm infants.
A prospective cohort study of 65 moderate-late preterm infants in a neonatal intensive care unit involved the evaluation of general movements, the Nursery Neurobiologic Risk Score, and the Perinatal Risk Inventory. Associations were analyzed using Fisher's exact test, Spearman's correlation was used for ordinal variables, and backward stepwise logistic regression was used to identify predictor variables for the assessments.
The findings indicated a high prevalence of normal (41%) and poor (52%) repertoire patterns during the writhing period. While no significant associations were found between the three assessments, a slight approximation emerged between dysmorphic traits and patterns (
= 0.053). Furthermore, an extended period of ventilation correlated with a higher likelihood of developing a cramped synchronized pattern and there was a correlation between both risk factor-based tools (
< 0.001).
This research enhances our understanding of the early impact on general movement assessments in moderate-late preterm infants. While no clear relationship emerged between general movement assessment and risk factor-based tools, there was a subtle connection noted with dysmorphic traits. A longer ventilation duration was linked to a higher risk of developing cramped synchronized patterns.
Rehabilitation of walking ability is one of the most important objectives after a spinal cord injury. Robotic and neuroprosthetic technologies hold a considerable potential for driving walking ...rehabilitation therapies. However, new developments are needed in order to improve the walking rehabilitation interventions based in these technologies.
We recently presented a cooperative control strategy of Kinesis, a lower limb exoskeleton for providing hybrid therapy of walking (Del-Ama, 2014). Its design aimed to actively manage muscle fatigue caused by surface electrical stimulation, and to implement the assist-as-needed control paradigm in which both stimulation and robotic controller cooperate with the residual functionality of the user. In this article we present three case studies for investigating the feasibility of the hybrid therapy of walking delivered with Kinesis in patients with incomplete spinal cord injury. Besides, the adaptability features of Kinesis stimulation–robot cooperative control are assessed, characterizing the behavior of the cooperative controller while providing hybrid therapy of walking.
Patients with incomplete spinal cord injury participated in the experiments. The protocol consisted of walking with Kinesis during 6 min. Three configurations of the cooperative controller were tested for each patient in separate sessions in order to investigate its adaptability features. The immediate impact of the hybrid therapy of walking was assessed through several variables that represent the physiological impact, user–exoskeleton physical interaction, stimulation intensity and user subjective perception of the hybrid therapy of walking.
Results show that the cooperative controller of Kinesis adapted to patient functional deficits and voluntary actions during walking, modulating stimulation and robotic assistance, which was the aim of the controller design. Nevertheless, no noticeable differences were observed in the comparison between compliant and trajectory exoskeleton control. Further work is envisioned regarding several aspects of hybrid walking control: stimulation control based on muscle activation estimate, improved semi-automatic control of walking, and improved muscle fatigue monitoring. The hybrid walking therapy was tolerated by the patients without adverse effects, along with a tolerable physical demand. This shows a potential for walking rehabilitation in motor incomplete SCI patients, guaranteeing further research on this topic.
•We investigate the feasibility of providing the hybrid therapy of walking with Kinesis hybrid exoskeleton.•We compare and investigate the role of the stimulation and the compliant robot control.•Three case studies are presented. The cooperative controller of Kinesis adapted to patients and voluntary actions.•No noticeable differences were observed between compliant and trajectory control.
The purpose of this study was to assess the use of diagnostic assessment tools in pediatric physical therapy practice in Spain. Best practice recommendations indicate the timely use of key assessment ...tools to reduce the age of diagnosis of cerebral palsy (CP).
Pediatric physical therapists currently working in Spain in early intervention were recruited through targeted physical therapy entities. They were invited to complete the purpose-developed electronic survey, consisting of 45 multiple-choice questions, with 5 thematic blocks.
Results from 140 anonymous respondents were analyzed. The average reported age when CP was suspected was 12.6 months. Most used the child's clinical history (88.1%), the Alberta Infant Motor Scale (41.3%), and Vojta Assessment Procedure (32.1%) to assess and detect CP. General Movements Assessment (25.7%) and Hammersmith Infant Neurological Examination (28.4%) were used infrequently.
Currently, pediatric physical therapists in Spain rely on clinical history and outdated tools to identify children with CP.Digital Abstract available at: http://links.lww.com/PPT/A361 (English).Digital Abstract available at: http://links.lww.com/PPT/A362 (Spanish).
Our main goal was to measure physical activity (PA) in people with paraplegia. Secondarily, we aimed to establish the relationship between being engaged in physical exercise (PE) and reaching the ...recommended moderate-to-vigorous physical activity (MVPA) level. We further analyzed the effect of being engaged in PE on the PA levels.
Descriptive cross-sectional.
Spanish associations for individuals with spinal cord injury.
Ninety-six manual wheelchair users with chronic paraplegia.
Participants wore a wrist accelerometer for one week.
Levels of PA and sedentary behavior. In addition, participants were classified into two groups, exercisers (EG) and non-exercisers (NEG) to analyze the effect of PE enrollment on the variables.
For all participants, a mean (SD) of 5,341.70 (966.4) minutes per week were spent engaged in sedentary behaviors, 2,188.99 (723.9) minutes were spent engaged in light activity, and 206.24 (180.0) minutes were spent engaged in MVPA. There was a significant relationship between PE and reaching the minimum levels of MVPA recommended x
2
(1) = 25.03, P < 0.01. NEG showed a greater number of minutes per week for sedentary behavior t (94) = 2.50, P < 0.05, r = 0.25. The EG spent more than twice as much time doing MVPA than the NEG (263.8 min vs 114.3 min, respectively).
MVPA levels are low in manual wheelchair users who are not regular exercisers, but most of those who self-reported being regular exercisers reach the minimum levels recommended for health benefits. Sedentary behavior is a concern in this population.
Loss of motor function is a consequence after cervical spinal cord injury. Three-dimensional kinematic analysis equipments are used for quantifying human movements in clinical laboratories. These ...systems may provide objectivity to the patient assessments. Nowadays, the kinematic variables found in the literature have some deficiencies, and the efficient management of these data sets is a demand and a challenge in the clinical setting. The aim of the present paper is to propose a set of novel kinematic indices, as a combination of kinematic variables, for quantifying upper limb motor disorders in terms of characteristics in relation to ability and dexterity such as accuracy, efficiency, and coordination. These indices are defined for measuring patients’ motor performance during the activity of daily living of drinking from a glass. This task is included within the upper limb rehabilitative process that patients receive. The main contribution of this research, with the aim of detecting upper limb impairments in patients, consists of the proposal of three kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.
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