NeuroRehabilitation - Volume 28, issue 4

Authors: Gaber, Tarek A.-Z.K. | Basu, Bhaskar | Shakespeare, David | Singh, Rajiv | Salam, Sohail | McFarlane, John

Article Type: Research Article

Abstract: Introduction: Hyperextension of the extensor hallucis longus (EHL) muscle is a well recognised disabling sequel of either pyramidal or extrapyramidal lesions causing what is known as striated or hitchhiker’s toe. Surgery was the only effective strategy to manage EHL hyperextension before botulinum toxin’s use to manage muscular dystonia and spasticity became widely popular. Methods: A multicentre retrospective study. A standard proforma was sent to specialists in neurological rehabilitation dealing routinely with this problem. The data was analysed using descriptive statistics. Results: Four consultants and two trainees representing five separate neurological rehabilitation services agreed to participate in …the study. Full data was available from the 29 proformas completed. The subjects were 15 females with an age range between 20 and 78 years (mean 58.7). Stroke was the primary diagnosis in 18 subjects. Four subjects had bilateral involvement. 16 subjects had either an associated foot drop or equino varus deformity. Dysport® was used in 15 subjects with an average dose of 170 units per injection and Botox® in the other 14 with an average dose of 65 units. The treatment was effective in 24 subjects (83%). All patients receiving Dysport® responded to the treatment. Whilst 5 Botox® treated patients failed to respond to it (35% failure rate). Most of the non respondents seemed to receive insufficient doses of Botox® (below 60 units). Surgical management was successful in 3 out of the 5 non respondent cases. Conclusion: Botilinum Toxin is an effective and safe method to manage hitchhicker’s toe. In our study the conversion ratio between Dysport® and Botox® was 2.5:1. Third of the patients receiving Botox® failed to respond to the treatment most probably due to insufficient doses used. Show more

Keywords: Botulinum Toxin, extensor hallucis longus, hitchhiker's toe, spasticity

DOI: 10.3233/NRE-2011-0669

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 395-399, 2011

Authors: Schuler, Tabea | Brütsch, Karin | Müller, Roland | van Hedel, Hubertus J.A. | Meyer-Heim, Andreas

Article Type: Research Article

Abstract: Patient's active cooperation is essential to achieve good outcome in pediatric rehabilitation. Therefore, virtual environments were developed to enhance robotic assisted gait training. The purpose of this study was to evaluate virtual realities as motivational tools during robotic assisted gait training with children in the pediatric Lokomat® . Nine children with different gait disorders and eight healthy children participated in the study. Muscular effort of the lower leg was assessed by surface electromyography during a randomly designed training protocol with virtual realities. Self reported motivation was investigated with two questionnaires. Comparisons were drawn through repeated measurement Analysis of Variance and …paired-t-tests. The logarithmic transformed data showed that the electromyographic activity output in both groups was significantly higher during tasks with virtual realities than during normal walking conditions. These results support that virtual realities seem to be efficient motivational tools to increase children's muscular effort in the pediatric Lokomat®. The gaming aspect of virtual realities keeps children highly engaged during repetitive tasks. Show more

Keywords: Children, motor impairments, electromyography, motivation, robotic assisted gait training, virtual realities

DOI: 10.3233/NRE-2011-0670

Citation: NeuroRehabilitation, vol. 28, no. 4, pp. 401-411, 2011