Neurorehabilitation (NEUROREHABILITATION)

Publications in this journal

• Article: A meta-analysis of functional outcome among older adults with traumatic brain injury.

  Amanda McIntyre, Swati Mehta, Shannon Janzen, Joanne Aubut, Robert W Teasell
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  ABSTRACT: OBJECTIVE: The objective of this study was to determine rates of functional outcomes, based on Glasgow Outcome Scale scores, among older adults (>60 years) after a traumatic brain injury. METHODS: An extensive database search was conducted. To be included all articles were published in English, included individuals 60 years or older, explicitly stated in-hospital GCS scores and GOS scores within one year post-TBI. Data was pooled on patient characteristics, mortality rates, time to death, and study design. RESULTS: A total of 11 studies were included in this review. Among individuals with severe TBI, favourable, unfavourable, and fatal outcomes were observed in 7.9% (CI 5.3%-11.8%), 13.8% (CI 10.0%-18.8%) and 79.3% (CI 73.2%-84.4%), respectively. Among those with moderate TBI, favourable, unfavourable, and fatal outcomes were observed in 32.2% (CI 18.0%-50.7%), 29.5% (CI 16.5%-47.0%), and 42.5% (CI 26.1%-60.7%), respectively. Among those with mild TBI, favourable, unfavourable, and fatal outcomes were observed in 80.5% (CI 53.2%-93.7%), 7.0% (CI 1.9%-22.7%), and 10.7% (CI 3.1%-30.9%), respectively. CONCLUSION: This study has demonstrated the significant interaction between GCS and GOS among older adults. Although older adults may require aggressive and comprehensive treatment to achieve these favourable outcomes, high rates of unfavourable outcome should not justify the use of conservative treatment.
  Neurorehabilitation 01/2013; 32(2):409-414.
• Article: Comparison of gait training versus cranial osteopathy in patients with Parkinson's disease: A pilot study.

  Thomas Müller, Angela Pietsch
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  ABSTRACT: A physiotherapy subtype is gait training (GT), which aims on correction of posture and gait re-education in patients with Parkinson's disease (PD). Osteopathy in the cranial field (OCF) is a gentle manual method to treat dysfunctions of the central nervous system. Therapists may employ GT and OCF to bypass deficient basal ganglia dysfunction, which causes gait disturbances in PD. Objectives of this pilot study were to demonstrate the efficacy of both procedures on gait and to compare their effects within a cross over design. 18 PD patients received on two subsequent days one GT- and one OCF session each. The ten meter walking test (WT) was performed before and after each therapeutic intervention. GT reduced the number of steps but not the interval in the WT. OCF declined the period but not the step frequency in the WT. The computed differences of WT outcomes before and after each intervention did not vary between both methods. Both sessions together shortened the interval but not number of steps in the WT. GT improves walking behaviour with a specific focus on an optimised performance of the necessary movement sequences regarding their accuracy and amplitude. As OCF decreased the interval, it ameliorates speed of motion execution during gait. GT and OCF enhance different aspects of gait in PD.
  Neurorehabilitation 01/2013; 32(1):135-40.
• Article: Sexuality after traumatic brain injury: A critical review.

  Jhon Alexander Moreno, Juan Carlos Arango Lasprilla, Caron Gan, Michelle McKerral
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  ABSTRACT: Brain injury can directly and indirectly affect important aspects related to sexuality and sexual function. In this critical review of the literature, traumatic brain injury (TBI) and sexuality are examined. A general review of the concept of sexuality and the neurological correlates of sexual function are proposed as a framework to understand the cognitive, behavioral and physical effects of TBI on sexuality and sexual function. Studies are then classified according to the participants enrolled and findings are presented from the professional's, the survivor's, the patient/partner's, and the non-injured spouse's perspectives. Results are discussed taking into account methodological limitations and knowledge gaps. Next, implications for sexual rehabilitation for individuals with TBI are discussed. Finally, suggestions for future research and their pertinence for improving rehabilitation outcomes are considered.
  Neurorehabilitation 01/2013; 32(1):69-85.
• Article: Validity and reliability of a new test for Turkish-speaking aphasic patients: Ege Aphasia Test.

  Funda Atamaz Calis, Arzu Yagiz On, Berrin Durmaz
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  ABSTRACT: Due to the fact that the phonetic, morphological and syntactic structures of the Turkish language differ significantly from other European languages, the translated forms of the currently available aphasia assessment batteries are not adequate for Turkish-speaking aphasic patients. The aim of this study was to assess the validity and reliability of the Ege Aphasia Test that we have developed. The test, which includes the 8 subtests of praxia, spontaneous language, auditory and verbal comprehension, repetition, naming, reading, writing and calculating, was applied into 100 aphasic patients, 40 dysarthric patients and 40 healthy subjects. All test-retest intra-class correlation coefficients were found to be excellent (ICC = 0.99). The Cronbach's coefficients ranged from 0.71 to 0.91. All the subtests showed significantly greater scores in aphasic patients (p < 0.05). Significant correlations were found between the subtests and corrected total score (p < 0.05). Finally, the Ege Aphasia Test has an acceptable validity and reliability. It seems to be a promising battery for evaluation of aphasia in the Turkish language, which is spoken mainly in Turkey and in the surrounding regions. We believe that this study will pioneer the development of aphasia rehabilitation in these countries and contribute to future studies.
  Neurorehabilitation 01/2013; 32(1):157-63.
• Article: The effect of vibration therapy on spasticity and motor function in children with cerebral palsy: A randomized controlled trial.

  Ana Katusic, Sonja Alimovic, Vlatka Mejaski-Bosnjak
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  ABSTRACT: As the motor system relies heavily on deep sensory stimulation, recent studies have investigated the effect of vibration stimuli. Although research suggests a positive influence of vibration on motor performance in individuals with neurological disorders, there are very limited numbers of studies in children with cerebral palsy (CP). The objective of the present study was to evaluate the effects of sound wave vibration therapy on spasticity and motor function in children with CP. In this 3-month trial, 89 children with spastic CP were randomized to either continue their physiotherapy treatment (PT) or to receive vibration therapy twice a week in addition to their PT program. The randomization was stratified according to the Gross Motor Function Classification System (GMFCS) level to ensure similar functional ability. Children were assessed at baseline and after the 12-week intervention period. The outcomes measured were spasticity level as assessed by Modified Modified Ashworth Scale (MMAS) and gross motor function as assessed by Gross Motor Function Measurement (GMFM-88). Subgroup analysis was performed for the GMFCS. Significant differences between groups were detected for changes in spasticity level and gross motor function after the three months intervention. In conclusion, vibration therapy may decrease spasticity and improve motor performance in children with CP. The results of the present trial serve as valuable input for evidence-based treatments in paediatric neurorehabilitation.
  Neurorehabilitation 01/2013; 32(1):1-8.
• Article: Motor imagery training in patients with chronic neglect: A pilot study.

  Gundhild Leifert-Fiebach, Anouk Welfringer, Ralf Babinsky, Tobias Brandt
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  ABSTRACT: Only few studies have investigated the effects of motor imagery training (MIT) on neglect symptoms. To investigate the imagery ability of patients with visuospatial neglect and the behavioral effects of MIT on neglect symptoms. In an intense four-week course 10 patients with chronic visuospatial neglect symptoms resulting from right-hemisphere lesions practiced MIT by mentally envisaging positions and movements of the contralesional upper limb. Visual and kinesthetic MIT abilities as well as neglect-related disability were evaluated prior to and following therapy. Neglect symptoms were as well assessed at three-month follow-up. Results suggest that (i) the ability to perform motor imagery is principally retained in patients with neglect and even patients that are seemingly incapable of motor imagery are able to relearn imagined activation via an individualized training approach. Furthermore, imagined activation of the left arm (ii) significantly reduces the severity of neglect in exploration, (iii) enhances temporal and spatial orientation, and (iiii) significantly improves the kinesthetic motor-imagery capacity and ability. These improvements were stable over a three-month period, indicating long-term training effects. Our data suggest that active kinesthetic-motor imagery is a feasible and effective training method for patients suffering from chronic visuospatial neglect symptoms.
  Neurorehabilitation 01/2013; 32(1):43-58.
• Article: TBI and Aging.

  Wayne A Gordon
  Neurorehabilitation 01/2013; 32(2):197-198.
• Article: Perception of muscular effort in multiple sclerosis.

  Anita Kiselka, Andrea Greisberger, Mario Heller
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  ABSTRACT: BACKGROUND: Resistance exercise is effective in improving muscle strength and preventing muscle weakness in multiple sclerosis (MS) patients. Control of resistance training intensity based on perceived muscular effort is applicable to healthy individuals, yet there is no evidence of its utility for MS patients. OBJECTIVE: To compare perception of muscular effort in MS patients to healthy controls. METHODS: Based on their perception of muscular effort, twenty-five MS patients and twenty-eight controls adjusted static elbow extension tasks according to five levels on the OMNI-Resistance Exercise Scale. Elbow extension strength and muscle activity were measured via load cell dynamometer and surface electromyography (EMG) and related to each participant's maximal voluntary contraction (MVC) strength and muscle activity. Two-way analysis of variance was used to evaluate statistical significance. RESULTS: There were no statistically significant differences between MS patients and healthy controls, they produced similar relative torque values (F1 = 0.196; p > 0.05) and extensor muscle activities (F2,617 = 1.556; p > 0.05) across all effort levels. CONCLUSION: No differences were found in the perception of muscular effort in MS patients and the age-matched control group. Future studies should explore, whether rating of perceived exertion is an effective instrument to control resistance training intensity in MS patients.
  Neurorehabilitation 01/2013; 32(2):415-423.
• Article: Endurance exercise training protects against the upregulation of nitric oxide in the striatum of MPTP/probenecid mouse model of Parkinson's disease.

  Muhammed Al-Jarrah, Heyam Obaidat, Ziad Bataineh, Lori Walton, Ahed Al-Khateeb
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  ABSTRACT: Parkinson's disease (PD) is a neurodegenerative disorder, caused by the gradual loss of cells in substantia nigra. Nitric oxide (NO) plays an important role in a variety of signal transduction pathways that are crucial for maintaining the physiologic functions of nervous system. The aims of this study are: 1) To investigate the expression of the inducible form of NO (iNOS), and compare it to neuronal nitric oxide (nNOS) in the brain of a chronic mouse model of PD and 2) To study the effect of endurance exercise training on the expression of these markers. Mouse models of PD were obtained using 10 doses of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (25 mg/kg) and probenecid (250 mg/kg) over 5 weeks. Forty C57BL /6 albino mice were randomly divided into four groups: sedentary control (SC, N = 10), exercise control (EC, N = 10), sedentary PD (SPD, N = 10), exercise PD (EPD, N = 10). At the end of training program, nNOS and iNOS were evaluated in the striatum in all animal groups using immunohistochemistry. nNOS showed significant increases in striatum (ST) of SPD mice compared to SC mice (P > 0.03). There was also decreased expression of nNOS in EC group compared to SC mice, but this decrease was not significant (P > 0.8). Exercise training significantly decreased the level of nNOS in the EPD compared to SPD, (P > 0.04). Although, iNOS expression followed almost the same trend as nNOS, but exercise training did not significantly decrease the expression of iNOS in both EC and EPD groups, P > 0.2 and 0.3 respectively. The data from this study suggests that 4 weeks of treadmill exercise has a positive impact on the expression of nNOS and iNOS in the striatum of a PD model. This might clear in part the pathogenicity of the diseases and the positive impact of training on PD.
  Neurorehabilitation 01/2013; 32(1):141-7.
• Article: Vision rehabilitation for visual-vestibular dysfunction: The role of the neuro-optometrist.

  Allen H Cohen
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  ABSTRACT: This article discusses, in a clinically relevant format, the importance of including a neuro-optometrist as a member of the management team for patients with balance disorders. To review the importance of vision and visual processing for maintaining a sense of balance and equilibrium and the role of the neuro-optometrist in the overall rehabilitation of patients with balance disorders Dizziness, balance problems and the sensation that the space world is moving (vertigo) are one of the most commonly reported problems in general medical practice. Persons with a central nervous system injury or other idiopathic causes of visual processing problems or who have functional vision problems that are not adequately managed, often experience extreme difficulty with balance and movement, as well as with their perception of space. Consequently, the patient often experiences difficulty functioning in an environment with excessive visual stimulation such as a grocery store or shopping mall. Symptoms of disequilibrium, vestibular and balance problems are commonly a result of VOR disturbance secondary to an inner ear problem and an unstable binocularity. The combination of neuro-optomertic rehabilitative therapy and balance therapy will result in a is an effective treatment for reducing or resolving these symptoms.
  Neurorehabilitation 01/2013; 32(3):483-92.
• Article: Improvements in spasticity and motor function using a static stretching device for people with chronic hemiparesis following stroke.

  Hae Min Jo, Jun-Chan Song, Sung Ho Jang
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  ABSTRACT: We investigated the effect of a static stretching device on spasticity and motor function for people with chronic hemiparesis following stroke. Ten participants with chronic hemiparesis following stroke who had severe spasticity and incomplete weakness of the affected wrist and hand were recruited. The stretching device consisted of a resting hand splint, a finger and thumb stretching system, and a frame. The stretched state was maintained for 10 minutes/session, and the static stretching program was performed for 2 sessions/day and 7 days/week for 4 weeks. Spasticity and motor function of the affected wrist and hand were assessed three times with intervals of 4 weeks (twice [Pre-1, Pre-2] before and once [Post-1] after starting the static stretching program). The effect of the static stretching device was assessed using modified Ashworth scale (MAS) scores, by measuring active range of motion (AROM), and using the wrist and hand subsection of the Fugl-Meyer motor assessment (FMA). The main effects of the static stretching program on MAS scores for wrist and metacarpophalangeal (MCP) joints and FMA scores were significant. AROMs of MCPs and wrist showed an increase, however, no significant main effects of the static stretching program were observed. MAS in flexor muscles of MCP joints showed a significant decreased from Pre-2 (mean ± standard deviation (SD): 2.56 ± 0.55; median and interquartile range (IQR): 2.42, 2.12-3.08) to Post-1 (mean ± SD: 1.05 ± 0.49; median and IQR: 1.08, 0.87-1.50) (P < 0.001), and MAS in wrist flexor muscles also showed a significant decrease from Pre-2 (mean ± SD: 3.20 ± 0.78; median and IQR: 3.0, 2.75-4.0) to Post-1 (mean ± SD: 1.90 ± 0.73; median and IQR: 2.0, 1.0-2.5) (P < 0.001). FMA score also showed a significant increase from Pre-2 (11.3 ± 6.09) to Post-1 (14.5 ± 6.20) (P < 0.001). It was found that the static stretching device effectively relieved spasticity and improved motor function in subjects with severe spasticity and incomplete weakness following stroke.
  Neurorehabilitation 01/2013; 32(2):369-375.
• Article: A less conservative method to adjust for familywise error rate in neuropsychological research: The Holm's sequential Bonferroni procedure.

  Katie E Eichstaedt, Keith Kovatch, David Aaron Maroof
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  ABSTRACT: The traditional Bonferroni method is a commonly used post hoc hypothesis test to adjust for familywise error rate inflation; however, a less well-known derivative of this test, the Holm's sequential procedure, provides an alternative method for familywise error rate correction. This less conservative approach is particularly relevant to studies investigating neuropsychological functioning because of the extent to which neuropsychological datasets tend to include interrelated outcome measures, reducing the relevance of the universal null hypothesis assumption, on which the traditional Bonferroni method relies. Mathematical illustrations demonstrating how to compute the two adjustments are provided. The two methods are compared using a simple hypothetical dataset. By using the divisors (n - j + 1) in lieu of n, Holm's sequential procedure is guaranteed to never reject fewer hypotheses than the traditional Bonferroni adjustment. The Holm's sequential procedure corrects for Type I error as effectively as the traditional Bonferroni method while retaining more statistical power. Although the Holm's sequential procedure is more complicated to compute than the traditional Bonferroni method, the Holm's sequential procedure may be a more appropriate method for adjusting familywise error rate inflation in many types of neuropsychological research.
  Neurorehabilitation 01/2013; 32(3):693-6.
• Article: Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury.

  Laura Lei-Rivera, John Sutera, Jessica A Galatioto, Bryan D Hujsak, James M Gurley
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  ABSTRACT: Although a majority of patients following minor traumatic brain injury recover to their pre-morbid functional level, persistent activity and participation limitations can occur in the refractory patient. These long-term consequences of brain injury may only become apparent months to years after the injury. In order to quantify these long-term sequella, laboratory, clinical and functional outcome measures may not only identify needed areas of treatment, but may also assist in determining the impact of the treatment on the individuals function. The aim of this manuscript is to review the clinical utility of vestibular laboratory testing and the bedside vestibular examination in patients following mild traumatic brain injury. In addition, the validity and inter-observer reliability of functional outcome measures commonly used in individuals with mTBI will also be reviewed. Because of the diffuse pathology seen with mTBI, multiple tests are needed to determine the resultant impairment and their impact on the patient's activity level and participation level. Laboratory test and bedside tests of vestibular impairment are reviewed. Functional outcome measures including the Dynamic Gait Index, the Functional Gait Assessment, the Balance Error Scoring System, and Dual Task Performance are reviewed for their appropriateness in quantifying the effect of mTBI at activity level and participation level of the individual. TBI rehabilitation services are increasingly exemplified by the needs of patients, rather than by the underlying pathology or diagnosis. Basing treatment decisions and treatment timing on laboratory, clinical, and functional testing can optimize the rehabilitation outcome.
  Neurorehabilitation 01/2013; 32(3):463-72.
• Article: Just how bad is it? Comparison of the mental health of Mexican traumatic brain injury caregivers to age-matched healthy controls.

  Paul B Perrin, Lillian Flores Stevens, Teresita Villaseñor Cabrera, Miriam Jimenez-Maldonado, Maria Luisa Martinez-Cortes, Juan Carlos Arango-Lasprilla
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  ABSTRACT: To compare the mental health of family caregivers of individuals with Traumatic brain injury (TBI) to an age-matched healthy control from Guadalajara, Mexico. Hospital Civil Fray Antonio Alcade, a public medical facility in Guadalajara, Mexico. Ninety family caregivers of individuals with TBI and 89 healthy controls (n = 179) did not differ with respect to age, sex, marital status, education, or household income. Outcome measures assessed satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), social support (Interpersonal Support Evaluation List), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). A multivariate analysis of variance found that in comparison to controls, TBI caregivers reported substantially lower mental health scores across all indices, as well as lower social support in two out of three comparisons. The effect sizes of the social support differences were small; two out of five mental health differences reached medium-sized effects; and the other three reached large-sized effects. Because TBI caregivers' mental health influences the quality of informal care they can provide, mental health interventions for family caregivers are an extremely important part of TBI rehabilitation in Latin America, especially considering familism as a core value in Latino culture.
  Neurorehabilitation 01/2013; 32(3):679-86.
• Article: Segmental muscle vibration improves reaching movement in patients with chronic stroke. A randomized controlled trial.

  Emanuela Tavernese, Marco Paoloni, Massimiliano Mangone, Vesna Mandic, Patrizio Sale, Marco Franceschini, Valter Santilli
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  ABSTRACT: Segmental muscle vibration (SMV) has been used to improve gait and to reduce spasticity in stroke patients. No data exist about the possibility to improve upper limb motor function by using SMV. Forty-four patients with hemiparesis following chronic stroke were randomized to an experimental (n = 24) and a control group (n = 20). Patients in the experimental group received two weeks of general physical therapy and SMV over the biceps brachii and flexor carpi ulnaris muscles of the paretic side, while those in the control group received two weeks of general physical therapy. Kinematic analysis of reaching movement was performed at baseline and two weeks after treatment ended. Normalized jerk, indicating the smoothness of movement, significantly improved in the experimental group, with significant difference emerging between groups at the post-treatment evaluation. Patients in the experimental group also displayed a significant improvement for mean linear velocity, mean angular velocity at shoulder, distance to target at the end of movement and movement duration. No differences emerged between baseline and post-treatment evaluations in the control group. when added to general physical therapy, SMV is effective in improving, in a short-term period, upper limb motor performances of reaching movement in chronic stroke patients.
  Neurorehabilitation 01/2013; 32(3):591-9.
• Article: Correlation of trunk impairment with balance in patients with chronic stroke.

  G Jijimol, R K Fayaz, P V Vijesh
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  ABSTRACT: OBJECTIVE: To evaluate the correlation between the trunk impairment and balance in patients with chronic stroke. METHODS: Thirty subjects with chronic stroke participated in the study. The subjects were evaluated with the trunk impairment scale (TIS) and Tinetti balance scale (TBS). RESULT: Spearman's correlation showed highly significant correlation between TIS and TBS scores (rho = 0.911). CONCLUSION: The study reveals that the trunk impairment and balance in subjects with stroke are positively correlated with each other.
  Neurorehabilitation 01/2013; 32(2):323-325.
• Article: Changes of plantar pressure distributions following open and closed kinetic chain exercise in patients with stroke.

  Na Kyung Lee, Jung Won Kwon, Sung Min Son, Seok Hyun Nam, Yong Won Choi, Chung Sun Kim
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  ABSTRACT: OBJECTIVE: The aim of this study is to investigate whether progressive resistive training with closed-kinetic chain (CKC) and open-kinetic chain (OKC) exercises could change plantar pressure distribution during walking in patients with stroke. METHODS: Thirty-nine stroke patients were recruited and randomly divided into a CKC exercise group (n = 13), an OKC exercise group (n = 13), and a control group (n = 13). Both CKC and OKC exercise groups performed their own respective training programs 5 times per week for 6 weeks, whereas no training was done in the control group. Barefoot plantar pressure distribution was measured during walking in terms of contact area (CA), peak contact force (PCF), and contact impulse (CI) on each of three foot regions (i.e. forefoot (FF), midfoot (MF), and hindfoot (HF)). RESULTS: In the CKC exercise group, there were significant changes in only the CA and PCF of HF. In the OKC exercise and control groups, no significant differences were found for all variables of plantar pressure distributions. CONCLUSION: We found that resistive training with closed kinetic chain exercises could be an effective treatment method for improving normal gait patterns in stroke patients. These findings may be attributed to the fact that CKC exercise induced use of the ankle and knee muscles and provided repetitive sensory input from the affected foot.
  Neurorehabilitation 01/2013; 32(2):385-390.
• Article: Inpatient rehabilitation for traumatic brain injury: The influence of age on treatments and outcomes.

  Marcel Dijkers, Murray Brandstater, Susan Horn, David Ryser, Ryan Barrett
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  ABSTRACT: BACKGROUND: Elderly persons with traumatic brain injury (TBI) are increasingly admitted to inpatient rehabilitation, but we have limited knowledge of their characteristics, the treatments they receive, and their short-term and medium-term outcomes. This study explored these issues by means of comparisons between age groups. METHODS: Data on 1419 patients admitted to 9 inpatient rehabilitation facilities for initial rehabilitation after TBI were collected by means of (1) abstraction from medical records; (2) point-of care forms completed by therapists after each treatment session; and (3) interviews at 3 months and 9 months after discharge, conducted with the patient or a proxy. RESULTS: Elderly persons (65 or older) had a lower brain injury severity, and a shorter length of stay (LOS) in acute care. During rehabilitation, they received fewer hours of therapy, due to a shorter LOS and fewer hours of treatment per day, especially from psychology and therapeutic recreation. They regained less functional ability during and after inpatient rehabilitation, and had a very high mortality rate. CONCLUSIONS: Elderly people can be rehabilitated successfully, and discharged back to the community. The treatment therapists deliver, and issues surrounding high mortality need further research.
  Neurorehabilitation 01/2013; 32(2):233-252.
• Article: Effects of the progressive walking-to-running technique on gait kinematics, ultrasound imaging, and motor function in spastic diplegic cerebral palsy - an experimenter-blind case study.

  Nam Gi Lee, Su Ji Jeong, Joshua Sung Hyun You, Kang Hee Cho, Tae Heon Lee
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  ABSTRACT: The purpose of this study was to investigate the effects of the progressive walking-to-running technique (PWRT) in a child with spastic diplegic cerebral palsy (CP). A single case study with pre-/post-test. An 11-year-old male, diagnosed with spastic diplegic CP. The PWRT was provided for 60 minutes a day, 2 times a week for 12 weeks. Gross motor function tests, ultrasound imaging, hand-held dynamometer, and the Vicon motion capture system were used to determine motor function, muscle size and strength, and gait kinematics. Gross motor function was improved after the intervention. The size of right and left rectus femoris and tibialis anterior muscles in their contracted states were enhanced by 1.36, 5.09, 83.74, and 54.37%, respectively. Associated muscle strength was also increased by 58.8, 30.8, 28.0, and 118.2% in both rectus femoris and tibialis anterior muscles. Left stride length, walking speed, maximal flexion-extension angular excursion of the hip joint were enhanced by 95.7, 87.8, and 100.4% after PWRT, respectively. Our novel walking-running training paradigm was effective for restoring gait and running ability in a child with spastic diplegic CP.
  Neurorehabilitation 01/2013; 32(1):17-26.