After discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year. One hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription. The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections. This study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis. ClinicalTrials.gov: NCT02202954 , July 29, 2014.

There has recently been increasing interest in postural stability aimed at gaining a better understanding of the human postural system. This system controls human balance in quiet standing and during locomotion. Parkinson’s disease (PD) is the most common degenerative movement disorder that affects human stability and causes falls and injuries. This paper proposes a novel methodology to differentiate between healthy individuals and those with PD through the empirical mode decomposition (EMD) method. EMD enables the breaking down of a complex signal into several elementary signals called intrinsic mode functions (IMFs). Three temporal parameters and three spectral parameters are extracted from each stabilometric signal as well as from its IMFs. Next, the best five features are selected using the feature selection method. The classification task is carried out using four known machine-learning methods, KNN, decision tree, Random Forest and SVM classifiers, over 10-fold cross validation. The used dataset consists of 28 healthy subjects (14 young adults and 14 old adults) and 32 PD patients (12 young adults and 20 old adults). The SVM method has a performance of 92% and the Dempster–Sahfer formalism method has an accuracy of 96.51%.

Background: In spastic paresis, the respective contributions to active function of antagonist hypoextensibility, spasticity, and impaired descending command remain unknown. Objectives: We explored correlations between ambulation speed and coefficients of shortening, spasticity and, weakness for three lower limb extensors.Methods: This retrospective study identified 140 subjects with chronic hemiparesis (>6 months since injury) assessed during a single visit with barefoot 10-meter ambulation at comfortable and fast speed, and measurements of passive range of motion (X_V1), angle of catch at fast stretch (X_V3) and active range of motion (X_A) against the resistance of gastrocnemius, rectus femoris, and gluteus maximus. Coefficients of shortening (C_SH=[X_N-X_V1]/X_N; X_N, normal expected amplitude based on anatomical values), spasticity (C_SP=[X_V1-X_V3]/X_V1), and weakness (C_WK=[X_V1-X_A]/X_V1) were derived. For each muscle, multivariable analysis explored C_SH, C_SP, and C_WK as potential predictors of ambulation speed.Results: Ambulation speed was 0.62±0.28m/s (mean±SD, comfortable) and 0.84±0.38m/s (fast) and was correlated with C_SH and C_WK against gastrocnemius (C_SH, comfortable, ns; fast, β=−0.20, p=.03; C_WK, comfortable, β=−0.21, p=.010; fast, β=−0.21, p =.012), rectus femoris (C_SH, comfortable, β=−0.41, p=6E⁻⁷; fast, β=−0.43, p=5E⁻⁷; C_WK, comfortable, β=−0.36, p=5E⁻⁵; fast, β=−0.33, p=.0003) and gluteus maximus (C_SH, comfortable, β=−0.19, p=.02; fast, β=−0.26, p=.002; C_WK, comfortable, β=−0.26, p=.002; fast, β=−0.22, p=.010). Ambulation speed was not correlated with C_SP.Conclusions: In chronic hemiparesis, ambulation speed correlates with coefficients of shortening and of weakness in lower limb extensors, but not with their spasticity level. This may encourage therapists to focus treatment primarily on muscle shortening by stretching programs and on impaired descending command by active training.

Understanding the behavior of the human postural system has become a very attractive topic for many researchers. This system plays a crucial role in maintaining balance during both stationary and moving states. Parkinson’s disease (PD) is a prevalent degenerative movement disorder that significantly impacts human stability, leading to falls and injuries. This research introduces an innovative approach that utilizes a hidden Markov model (HMM) to distinguish healthy individuals and those with PD. Interestingly, this methodology employs raw data obtained from stabilometric signals without any preprocessing. The dataset used for this study comprises 60 subjects divided into healthy and PD patients. Impressively, the proposed method achieves an accuracy rate of up to 98% in effectively differentiating healthy subjects from those with PD.

After a stroke, antagonist muscle activation during agonist command impedes movement. This study compared measurements of antagonist muscle activation using surface bipolar EMG in the gastrocnemius medialis (GM) and high-density (HD) EMG in the GM and soleus (SO) during isometric submaximal and maximal dorsiflexion efforts, with knee flexed and extended, in 12 subjects with chronic hemiparesis. The coefficients of antagonist activation (CAN) of GM and SO were calculated according to the ratio of the RMS amplitude during dorsiflexion effort to the maximal agonist effort for the same muscle. Bipolar CAN (BipCAN) was compared to CAN from channel-specific (CsCAN) and overall (OvCAN) normalizations of HD-EMG. The location of the CAN centroid was explored in GM, and CAN was compared between the medial and lateral portions of SO. Between-EMG system differences in GM were observed in maximal efforts only, between BipCAN and CsCAN with lower values in BipCAN (p < 0.001), and between BipCAN and OvCAN with lower values in OvCAN (p < 0.05). The CAN centroid is located mid-height and medially in GM, while the CAN was similar in medial and lateral SO. In chronic hemiparesis, the estimates of GM hyperactivity differ between bipolar and HD-EMGs, with channel-specific and overall normalizations yielding, respectively, higher and lower CAN values than bipolar EMG. HD-EMG would be the way to develop personalized rehabilitation programs based on individual antagonist activations.