Biomedical subjects

Janis J Daly

Publications and source records attributed to Janis J Daly.

8 recordsLinked to original sources

PubMed2006

Intra-limb coordination deficit in stroke survivors and response to treatment.

PURPOSE: Purpose one was to characterize the consistency of intra-limb hip/knee (H/K) coordination according to a measure of average coefficient of correspondence (ACC) across strides. Purpose two was to investigate H/K ACC validity and ability to discriminate pre-/post-treatment change in stroke survivors. METHODS: Five healthy controls and 32 chronic (>12 mos) stroke survivors were enrolled, and H/K ACC was calculated for both groups. Comparison between controls and stroke was made using the Mann-Whitney Test. Convergent validity of H/K ACC was tested using the Pearson Correlation model with gait speed and the 6 min Walk Test (6MWT). Stroke survivors were randomized to either: (1) gait training with functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes or (2) gait training without FNS. Both groups had treatment 1.5 h/day, 5 days/week, for 12 weeks, including .5 h coordination exercise, .5 h body weight supported treadmill training (BWSTT), and .5 h over ground gait training. The FNS-IM group used FNS-IM for all treatment components; the No-FNS group did not. Pre-/post-treatment comparisons were made using ANOVA. RESULTS: H/K ACC detected a significant difference between controls versus stroke involved limb (p=.0001) and controls versus stroke uninvolved limb (p=.042). The H/K ACC measure was well-correlated with gait speed (r=.70) and 6MWT (r=.69). H/K ACC showed a significant treatment response to FNS-IM (p=.003), but not No-FNS (p=.747). CONCLUSIONS: H/K ACC sensitively discriminated between controls versus stroke involved or uninvolved limbs. H/K ACC was valid, with significant correlations with both walking speed and 6MWT. FNS-IM produced a significant gain in H/K ACC, and No-FNS did not.

Adult↗

PubMed2006

Prolonged cognitive planning time, elevated cognitive effort, and relationship to coordination and motor control following stroke.

Understanding cortical function can provide accurately targeted interventions after stroke. Initially, stroke survivors had prolonged cognitive planning time and elevated cognitive effort, highly correlated with motor control impairments. Exploratory results suggest that neurorehabilitation, accurately targeted to dyscoordination, weakness, and dysfunctional task component execution, can improve cognitive processes controlling motor function.

Adaptation, Physiological↗

PubMed2006

Response of gait deficits to neuromuscular electrical stimulation for stroke survivors.

Persistent gait deficits after stroke can cause falls, elevated energy cost and poor endurance. Coordination impairment is an underlying cause of gait deficits. Few efficacious interventions have been described that have targeted and measured restoration of coordinated gait components. Neuromuscular electrical stimulation can provide the critical gait practice characteristic of close-to-normal movements, by electrically inducing muscle contractions and coordinated movements that are not possible under volitional effort. Two-channel, surface neuromuscular electrical stimulation can be synchronized with phases of gait and can provide faster, more symmetrical neuromuscular electrical stimulation-assisted gait than gait with no neuromuscular electrical stimulation. Difficulties encountered during the use of surface neuromuscular electrical stimulation for gait training led to the development of neuromuscular electrical stimulation with implanted technologies. Implanted electrodes and/or stimulators proved to be feasible for gait training in stroke survivors. Gait training with a multichannel neuromuscular electrical stimulation system with implanted electrodes proved more advantageous than gait training without neuromuscular electrical stimulation, according to measures of volitional coordinated gait components (neuromuscular electrical stimulation deactivated).

Electric Stimulation Therapy↗

PubMed2005

A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects.

BACKGROUND AND PURPOSE: Conventional therapies fail to restore normal gait to many patients after stroke. The study purpose was to test response to coordination exercise, overground gait training, and weight-supported treadmill training, both with and without functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes (FNS-IM). METHODS: In a randomized controlled trial, 32 subjects (>1 year after stroke) were assigned to 1 of 2 groups: FNS-IM or No-FNS. Inclusion criteria included ability to walk independently but inability to execute a normal swing or stance phase. All subjects were treated 4 times per week for 12 weeks. The primary outcome measure, obtained by a blinded evaluator, was gait component execution, according to the Tinetti gait scale. Secondary measures were coordination, balance, and 6-minute walking distance. RESULTS: Before treatment, there were no significant differences between the 2 groups for age, time since stroke, stroke severity, and each study measure. FNS-IM produced a statistically significant greater gain versus No-FNS for gait component execution (P=0.003; parameter estimate 2.9; 95% CI, 1.2 to 4.6) and knee flexion coordination (P=0.049). CONCLUSIONS: FNS-IM can have a significant advantage versus No-FNS in improving gait components and knee flexion coordination after stroke.

Aged↗

PubMed2004

Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training.

More than 3 million stroke survivors live with residual disabilities and mobility deficits even after rehabilitation. Therefore, it is important to develop new, more effective, gait training methods. The purpose of this study was twofold: (1) testing the feasibility of combining multi-channel functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes and body weight supported treadmill training (BWSTT) for gait training; and (2) documenting the potential gait practice advantages afforded by combining FNS-IM and BWSTT. Eight subjects with gait deficits in the chronic phase (>12 months) were enrolled. Intramuscular electrodes were placed in the paretic hip abductors, knee flexors and extensors, and ankle dorsiflexors, plantarflexors, and evertors. Subjects were treated with exercise and gait training using the combined technologies 1 1/2 h/week, four times/week, for 12 weeks. Feasibility was tested according to performance of the technologies, clinician skill factors, and subject satisfaction. Impairment, function, and quality of life were measured. Provision of practice for eight gait characteristics was catalogued. We found the following results for the combined technologies: (1) the combined technologies were safe and feasible; (2) clinicians required five training sessions to reach proficiency; (3) subjects were satisfied; (4) there were significant gains in impairment and functional measures; (5) a greater number of gait practice characteristics were provided with the combined technologies than with either alone.

Aged↗

PubMed2003

The FNS project.

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

Response of sagittal plane gait kinematics to weight-supported treadmill training and functional neuromuscular stimulation following stroke.

After stroke, persistent gait deficits cause debilitating falls and poor functional mobility. Gait restoration can preclude these outcomes. Sixteen subjects (>12 months poststroke) were randomized to two gait training groups. Group 1 received 12 weeks of treatment, 4 times a week, 90 min per session, including 30 min strengthening and coordination, 30 min over-ground gait training, and 30 min weight-supported treadmill training. Group 2 received the same treatment, but also used functional neuromuscular stimulation (FNS) with intramuscular (IM) electrodes (FNS-IM) for each aspect of treatment. Outcome measures were kinematics of gait swing phase. Both groups showed no significant pre-/posttreatment gains in peak swing hip flexion. Group 1 (no FNS) had no significant gains in other gait components at posttreatment or at follow-up. Group 2 (FNS-IM) had significant gains in peak swing knee flexion and mid-swing ankle dorsiflexion (p < 0.05) that were maintained for 6 months.

Biomechanical Phenomena↗

PubMedDate not supplied

Response to upper-limb robotics and functional neuromuscular stimulation following stroke.

Twelve moderately to severely involved chronic stroke survivors (>12 mo) were randomized to one of two treatments: robotics and motor learning (ROB-ML) or functional neuromuscular stimulation and motor learning (FNS-ML). Treatment was 5 h/d, 5 d/wk for 12 wk. ROB-ML group had 1.5 h per session devoted to robotics shoulder and elbow (S/E) training. FNS-ML had 1.5 h per session devoted to functional neuromuscular stimulation (surface electrodes) for wrist and hand (W/H) flexors/extensors. The primary outcome measure was the functional measure Arm Motor Ability Test (AMAT). Secondary measures were AMAT-S/E and AMAT-W/H, Fugl-Meyer (FM) upper-limb coordination, and the motor control measures of target accuracy (TA) and smoothness of movement (SM). ROB-ML produced significant gains in AMAT, AMAT-S/E, FM upper-limb coordination, TA, and SM. FNS-ML produced significant gains in AMAT-W/H and FM upper-limb coordination.

Activities of Daily Living↗