Which training for preparing walking with functional electrical stimulation in complete SCI patient?

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no prevalence of side according to the prevalence of distal PN evidenced at qualitative diagnostic EMG analysis. These alterations were observed also at proximal muscles (RF and GM) in 3 of 10 patients. Baropodometric analysis revealed predominant displacement of center of pressure in the medio-lateral axis, supinated foot and hyper pressure in the metatarsal area during walking. Significant Trendelemburg sign were perceived on those patients with EMG deficit of GM. Discussion: Surface EMG associated with baropodometric test allows to show biomechanics disorders correlated with diabetic neuropathy before than there are clinical evidence. Their prompt correction reduce the risk of hyper pressure ulcerations. Fig. 1. Box plots of power distribution [0.25–0.35] Hz in EC, EO.

Reference coxofemoral, varum-valgus knee/heel were executed, and from COP series a set of 62 parameters were calculated divided into temporal, spectral and stochastic classes [2]. Results: The assessment of the pelvic structure in D and N showed a general trend towards the increase of the range of anteroposition, a larger presence of claw foot, valgus heel and toes deformities. A boxplot statistical analysis of posturographic parameters revealed that 80% of N subjects differs significantly from C relatively to Sway area parameters, Ellipsis 95%, RMS distance, the powers contained in [0.25–0.35] and [0.35–0.5] Hz in mediolateral (ML) direction; in particular, in the eyes closed (EC) acquisition for C, N, D groups. The diffusion coefficient (Dl) in the N increased from eyes open (EO) to EC, oppositely to C. Discussion: The presence of balance instability was revealed in N and D groups; a more thorough investigation of the correlation with R, foot and toes deformities, plantar callosity and ulcers should be pursued.

Reference [1] Sawacha Z, et al. Book of abstract. In: Siamoc Conference. 2005. [2] Chiari L, et al. Gait Posture 2000;12:225–34. doi:10.1016/j.gaitpost.2007.12.040 The role of surface EMG in diabetic foot treatment Z. Sawacha 1,∗ , A. Venturin 3 , G. Guarneri 2 , P. Contessa 1 , A. Scutari 3 , C. Zanardo 3 , G. Cristoferi 2 , A. Avogaro 2 , C. Cobelli 1 1

Department of Information Engineering, University of Padova, Padova, Italy 2 Department of Clinical Medicine & Metabolic Disease, University Polyclinic, Padova, Italy 3 Department of Medical Surgical Specialty, Orthopaedic Institute— Orthopaedic Rehabilitation, University Polyclinic, Padova, Italy Introduction: Peripheral neuropathy (PN) and blood vessels degeneration are two complications of diabetes which alters the biomechanics of gait, and eventually leads to the formation of callosity and ulcerations. Materials and methods: Gait and EMG analysis [1] were performed with a full-body markerset [2] on 10 neuropathics subjects. BTS motion capture system (6 cameras, 60–120 Hz) and surface EMG (POCKETEMG, 16 channels) synchronized with 2 Bertec force plates (FP4060-10), and integrated with 2 Imago S.n.c plantar pressure systems (0.64 cm2 resolution, 150 Hz) were used. Surface EMG were applied on the following muscles: peroneus longus (PL), tibialis anterior (TA), gastrocnemius (G), rectus femoris (RF) e gluteus medius (GM). From EMG has been obtained: time of muscle activation relative to gait cycle phase, delaies or not activation, generated electrical signal intensity, stiffness, rms value, mean frequency. Results: The main alteration both in term of activation or not activation, signal intensity and stiffness were noticed mainly at PL and G muscles, with

[1] Knafliz M, et al. J Appl Physiol 1988;57:767–71. [2] Sawacha Z, et al. Book of abstract. In: Siamoc Conference. 2005. doi:10.1016/j.gaitpost.2007.12.041 Which training for preparing walking with functional electrical stimulation in complete SCI patient? E. Bizzarini 1,∗ , C. Pinzini 1 , E. Girardi 2 , A. Zampa 1 , P. Di Benedetto 1 1

Department of Physical Medicine and Rehabilitation, S.P.I.N.A.L. Laboratory, A.S.S. No. 4 “Medio Friuli”, Udine, Italy 2 School of Physiotherapy, Udine University, Italy

Background and aims of the study: The use of functional electrical stimulation for the gait training as neuroprosthesis and as external control of walking has been studied by different authors. We know that walking with FES requires a specific training whose modalities are not definite [1]. Aims of the study was to test the feasibility and the effectiveness of a specific training for preparing walking with FES in complete spinal cord injured patients. Setting: Department of Physical Medicine and Rehabilitation, S.P.I.N.A.L. Laboratory, Udine, Italy. Methods: Subjects: We studied two thoracic level spinal cord injured patients, in a chronic phase (more than 2 years to the trauma). ASIA Impairment Scale A, Ashworth Scale 2, wheelchair locomotion. Methods: The system PO22 Stimulator Fequa was used for walking with FES. In the first phase of the training we use an isometric electrical stimulation program of the quadriceps with patient lied down with knee flexed of 20◦ and ankle fixed with 2 kg. Every day session of 30 min for a total time of 3 weeks have been realized. The program was then completed with a training at the cyclergometer with an active pedalling induced by alternated contraction of right and left quadriceps. This training with a duration for the single session of 60 min for three times a week was also completed in 3 weeks. Than the walking program was realized with body weight supported treadmill (TR Spacetrainer, TR Equipment-SWE). The suspension was graduated following the correct pattern of the gait. FES walking use four channel: quadriceps muscles are stimulated for hip and knee extension and the common peroneal nerve to elicit the flexion reflex. This phase was completed when gait was feasible on treadmill without body weight support. Results: We use isokinetic instrumentation to test torque of quadriceps isometric contraction electrical stimulated with PO22 Stimulator Fequa. We measured limb circumference and we used plicometric method to calculated the muscles area of the limb. We measured the respiratory gases exchanges at the mouth and the relative concentrations of O2 and CO2 (with the method of the mixing chamber to intervals of 20 s) through an analyzer (2900, Sensormedics Corporation, USA) to verify the O2 consumption at cyclergometer and the energetic cost of the gait with FES, with and without BWS. We registered the heart rate (Hr; S810, Polar Electro Oy-END) and the subjective index of fatigue (Borg scale). Discussion and conclusion: We believe that monitoring parameters of strength and efficiency of the muscles and the energetic cost of gait could

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Abstracts of the 2007 SIAMOC congress / Gait & Posture xxx (2008) xxx–xxx

permit the definition of a specific training to prepare spinal cord injured patients to walking with FES. Even an accelerated program could realize a gait which is correct from biomechanics point of view and advantageous from an energetic point of view.

A study encompassing normative data, the reliability and the use of stair tests in measuring mobility in hemiplegic patients P. Marchi ∗ , A. Merlo, M. Manca, E. Venturini, G. Ferraresi, S. Cavazza Movement Analysis Laboratory, Department Neuroscience and Rehabilitation Medicine, Arcispedale S.Anna, Ferrara, Italy

Reference [1] Trasher TA, Flett HM, Popovic MR. Gait training regim for incomplete spinal cord injury using functional electrical stimulation. Spinal Cord 2006;44(6):357–61. doi:10.1016/j.gaitpost.2007.12.042 Gait analysis in patients with post-stroke hemiparesis: A pilot study P. Contessa 1,∗ , E. Carraro 2 , V. Postal 2 , S. Masiero 2 , Z. Sawacha 1 , G. Don`a 1 , C. Cobelli 1 1

Department of Information Engineering, University of Padova, Padova, Italy 2 Department of Medical Surgical Specialty, Rehabilitation Service—Padova University Polyclinic, Padova, Italy Introduction: Stroke is the first cause of disability and impairment in developed countries because of the resulting reduced mobility, postural changes and balance problems. Rehabilitation during the chronic phase is aimed at preserving mobility and autonomy in daily activities and at reducing impairment. Purpose of the present study is to verify dynamic and cinematic alterations in deambulation and to correlate them with clinical assessments. Moreover, the effects of a standard rehabilitation program are evaluated after 2 weeks and 3 months. Methods: A chronic phase patient with left hemiparesis (E) was recruited for this study, which includes: (1) clinical evaluations with internationally accepted functional scales; (2) postural analysis using the Roemberg test and (3) gait analysis performed with a full-body markerset [1,2]. BTS motion capture system (6 cameras, 60 Hz) and surface EMG (Pocket EMG, 16 channels) synchronized with 2 Bertec force plates (FP4060-10), and integrated with 2 Imago S.n.c plantar pressure systems (0.64 cm2 resolution, 150 Hz) were used. As a comparison, a healthy subject was recruited for the same cinematic and dynamic evaluations. Results: The cinematic analysis has shown the ankle to be the most compromised joint, with reduced mobility. Therefore, the patient (E) compensates through an increased knee flexion on the affected side and with a knee momentum higher than the ankle’s. No substantial changes in clinical, cinematic and dynamic evaluations were observed before and after the treatment. Discussion: These initial data help to better understand deambulation features in chronic phase (E) patients. Such features will become clearer through analysis extended to other subjects.

Reference [1] Sawacha, et al.Proceeding of Siamoc. 2005. [2] Neckel, et al. J Neuroeng Rehabil 2006;3:17. doi:10.1016/j.gaitpost.2007.12.043

Introduction: The stair test (ST) is one of many tools used for assessing patient mobility. It provides for the assessment of motor ability in negotiating stairs and the time spent in ascending and descending is the unit used for measuring this capacity. The test is widely described in the literature associated with varying illnesses, however, studies related to patients with hemiplegia are rare [1] and the implementation of such tests within a clinical framework is somewhat limited. There are many differing tests due to the characteristics of the “instrument” itself (in terms of dimensions and the numbers of steps) and in terms of what exactly the patient is expected to do during the test. Objectives: At the Laboratory of Movement Analysis of Ferrara, we wished to use the ST for patients with hemiplegia (stroke by ischemia or haemorrhage), and, having encountered difficulty in gathering comparable data from the literature due to the varying methods by which tests were conducted, we proceeded to: • Establish normative data from a sample (control) population of normal healthy adults. • Assess ST inter-tester reliability on a sample of patients with hemiplegia. • Verify possible correlations with other tests regarding impairment and disability. Materials and methods: Fifty healthy adults and 37 patients with hemiplegia (mean age 54 ± 18 years) were assessed with ST. Inclusion criteria included the ability to negotiate stairs without assistance or with supervision and the use auxiliary and/or orthotic devices. Exclusion criteria were clinical instability, lower limb pain on weight bearing and an Functional Ambulation Classification (FAC) score of <3. The patients were instructed to ascend and descend, at their usual speed, a six step flight of stairs (height 16 cm, depth 32 cm and width 260 cm) with handrails on both sides. Timing began from the first foot contact with the step and stopped at the last one. Times up (TS) and times down (TD) were recorded separately. A trial test (T0) was performed first followed by three proper tests (T1) (T2) (T3). Three different testers recorded the readings at random. Hemiplegic patients were also subjected to the following assessments: Motricity Index (MI); Maximum Isometric Voluntary Contraction (MCVI) with Hand Held Dynamometer (HHD) of hip flexor muscles, knee extensors and foot dorsiflexors; FAC; Walking Handicap Scale (WHS); 10 m Walking Test (10 MWT). The correlation of readings taken by differing testers was calculated with one-way ANOVA. Inter-tester reliability was evaluated with the interclass correlation coefficient ICC2,1 . The distribution of TS and TD was compared with impairment and disability clinical indicators and correlations between TS and TD, and between TS, TD and the 10 MWT. Results: The control population showed a TS of 3.7 ± 0.8 s and a TD of 3.0 ± 0.7 s. The patient population showed a significant difference (p < 0.05 post hoc test) between T0 and the following T1, T2 and T3 test times had a mean TS of 8.6 ± 4.7 s and a mean TD of 9.0 ± 5.3 s. The significant differences between the TS and TD times for impaired patients are compatible with the degree of impairment found in the patient population examined. The literature shows that in healthy patients, TS is greater than TD whereas in impaired patients, TD is greater. Inter-tester reliability was excellent both in TS (ICC = 0.92) and TD (ICC = 0.92). TS and TD correlated very well (R2 = 0.8) and with 10 MWT (R2 = 0.8) while no correlation was found between TS, TD and MI, MCVI, FAC, WHS. Conclusions: Excellent inter-tester reliability was found in ST and a strong correlation with 10 MWT. Within a clinical framework, normative values need to be defined in context, given how TS and TD vary in line with set-up. The lack of correlation

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